Anti-Kickback Statute and DME

[adductorschlongus]

In a hospital employed setting...does assigning a wRVU towards dispensing DME violate the Anti-Kickback Statute? On a cursory search it appears that receiving payment/benefits from the DME company is a conflict. Any experience or insight from those who have been practicing as hospital employees?

Fraud & Abuse Laws

oig.hhs.gov

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[CutsWithFury]

In a hospital employed setting...does assigning a wRVU towards dispensing DME violate the Anti-Kickback Statute? On a cursory search it appears that receiving payment/benefits from the DME company is a conflict. Any experience or insight from those who have been practicing as hospital employees?

Fraud & Abuse Laws

oig.hhs.gov

No hospital would pay employed physicians money or given them RVU credit for dispensing DME. Makes zero sense from a profit standpoint. Most hospitals use a third party vendor to manage DME in clinics and they give them a contract on the deal.

 

[wakaflocka88]

No hospital would pay employed physicians money or given them RVU credit for dispensing DME. Makes zero sense from a profit standpoint. Most hospitals use a third party vendor to manage DME in clinics and they give them a contract on the deal.

100%, DME is a big money maker.

 

[DYK343]

In a hospital employed setting...does assigning a wRVU towards dispensing DME violate the Anti-Kickback Statute? On a cursory search it appears that receiving payment/benefits from the DME company is a conflict. Any experience or insight from those who have been practicing as hospital employees?

Fraud & Abuse Laws

oig.hhs.gov

Stark/anti kickback laws are very confusing and multifactorial. You might want to seek advice of a healthcare attorney

 

[PeaJay]

No hospital would pay employed physicians money or given them RVU credit for dispensing DME. Makes zero sense from a profit standpoint. Most hospitals use a third party vendor to manage DME in clinics and they give them a contract on the deal.

In my region the hospital does not use third parties.

DME revenue is definitely accounted for Similarly to how income generated by OR minutes, advanced imaging, etc are tallied. Each plays a role in determining compensation packages for salaried employees. Not to say that you are encouraged to dispense or order more as if you fall out of the “normal” range there will be inquiries.

 

[CutsWithFury]

In my region the hospital does not use third parties.

DME revenue is definitely accounted for Similarly to how income generated by OR minutes, advanced imaging, etc are tallied. Each plays a role in determining compensation packages for salaried employees. Not to say that you are encouraged to dispense or order more as if you fall out of the “normal” range there will be inquiries.

How? How does the hospital make money off the DME if they are giving physicians money back in the form of RVU payments?

 

[dtrack22]

How? How does the hospital make money off the DME if they are giving physicians money back in the form of RVU payments?

Do you know what commercial plans pay for a $25 pneumatic walking boot?

 

[CutsWithFury]

Do you know what commercial plans pay for a $25 pneumatic walking boot?

more than it costs. I get it. But why reimburse the docs via RVUs? I forsee excessive DME prescribing in that case

 

[PeaJay]

There is no direct compensation in all cases I am aware. No cash value or rvu allotment. It is just taken into account when setting salaries similar to OR utilization and other production measures.

The salaried guy slinging customs should be have that taken into consideration.

Is rewarding a provider for OR utilization incentivizing unneeded flaps for small soft tissue excisions, complex closures, etc? You know stuff that is justified but not always needed.

 

[dtrack22]

more than it costs. I get it. But why reimburse the docs via RVUs? I forsee excessive DME prescribing in that case

I’m sure docs have negotiated to get wRVU units assigned to all kinds of things that don’t have a formal RVU amount. OTC inserts dispensed, PRP, shockwave, etc. They are all reimbursable things similar to production.

But I would agree it’s rare for employed docs to get credit for DME. Like others have mentioned, it is most likely calculated as “revenue” that determines how much salary or guaranteed pay you are worth. Or to justify the $ per wRVU production pay the doc is getting.

There really shouldn’t be any kickback issues with it though, even if you are somehow compensated for DME. The only time hospitals or MSGs run into kickback issues is when they are non-profit and they are using ancillaries to pay you above the amount you are actually bringing in based on e/m and CPT codes billed/reimbursed. That’s where they can run into legal issues, at least that’s my understanding.

 

[adductorschlongus]

Per a Health Care Law attorney:

"Yes, for a physician to directly dispense non-exempt DME (beyond ambulatory aids) the physician would need to be enrolled as a DME supplier and would need to “personally” dispense, which requires a lot of steps.

I think it would be difficult to credit an employed physician with wRVUs for DME that the physician orders even if the physician performs all those steps because the DME would not be supplied by the physician. One workaround for other types of Stark DHS is for the hospital to establish separate stand-alone nonprofit subsidiaries which employ one or a small number of physicians, and can then provide the DHS and share the profits within the entity. I’ve seen this done with orthopedic groups and PT."