OIG ruling, what's legal and illegal?

[aneftp]

http://www.beckershospitalreview.co...ngements-with-ascs-could-lead-to-trouble.html

We all heard about this ruling late May/early June 2012.

A couple of my friends are involved in some of these structured shell companies.

They hired attorneys and supposedly their attorney tell them it's legal to have all anesthesia services in house and the surgery partners can still collect the anesthesia profits. This is in both California and Florida. One of the centers, the surgeons offered my buddy equal stake in the surgery center company (not separate anesthesia company) but I feel it's still illegal if my friend share the revenue with the surgeons.

I spoke with my attorney friend up in DC and he told me even a 1% kickback is still illegal. Doesn't matter how you structure the model. W2 vs 1099. In house vs. out of house.

He says the only way to avoid self referral is the surgeons collecting the anesthesia profits pull 100% of their cases out of their own centers. Obviously this defeats the purpose of being a partner in a surgery center.

What are your thoughts?

My attorney friend says you can still buy 50K box seats at the NBA arena, that's legal. But any revenue sharing is strictly illegal because of self referral for a physician owned center IF the physician brings any cases to his own center.

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[BLADEMDA]

http://www.beckershospitalreview.co...ngements-with-ascs-could-lead-to-trouble.html

We all heard about this ruling late May/early June 2012.

A couple of my friends are involved in some of these structured shell companies.

They hired attorneys and supposedly their attorney tell them it's legal to have all anesthesia services in house and the surgery partners can still collect the anesthesia profits. This is in both California and Florida. One of the centers, the surgeons offered my buddy equal stake in the surgery center company (not separate anesthesia company) but I feel it's still illegal if my friend share the revenue with the surgeons.

I spoke with my attorney friend up in DC and he told me even a 1% kickback is still illegal. Doesn't matter how you structure the model. W2 vs 1099. In house vs. out of house.

He says the only way to avoid self referral is the surgeons collecting the anesthesia profits pull 100% of their cases out of their own centers. Obviously this defeats the purpose of being a partner in a surgery center.

What are your thoughts?

My attorney friend says you can still buy 50K box seats at the NBA arena, that's legal. But any revenue sharing is strictly illegal because of self referral for a physician owned center IF the physician brings any cases to his own center.

The arrangement which is LEGAL (in my opinion) is being an employee of the Surgicenter. As am employee the jargon in the ruling doesn't apply as the goal is "efficient patient care" for the surgical center.

The other model which is legal is the standard "eat what you kill model" of the ASC.

In your case if the Anesthesia is an "equal partner" in the sugicenter and there is no no new "company" then perhaps that arrangement is legal just as being an employee is legal.

 

[aneftp]

The arrangement which is LEGAL (in my opinion) is being an employee of the Surgicenter. As am employee the jargon in the ruling doesn't apply as the goal is "efficient patient care" for the surgical center.

The other model which is legal is the standard "eat what you kill model" of the ASC.

In your case if the Anesthesia is an "equal partner" in the sugicenter and there is no no new "company" then perhaps that arrangement is legal just as being an employee is legal.

Blade. Thanks for the response.

That's the issue. Had an attorney down in Florida say something similar to what you just stated.

However 2 other attorneys (one in California and one in DC). Both say if surgeons own any part of surgery center and collect anesthesia profits that that's self referral and illegal even if its under the W2 surgery center employee model.

If surgery center is hospital owned than surgeon can collect anesthesia profits. But since surgeon is part owner that creates a self referral and thus illegal.

We all know surgeons have less incentive to bring cases to centers they don't have an equity stake.

So what I am getting at is varying opinions

 

[countingdays]

Blade. Thanks for the response.

That's the issue. Had an attorney down in Florida say something similar to what you just stated.

However 2 other attorneys (one in California and one in DC). Both say if surgeons own any part of surgery center and collect anesthesia profits that that's self referral and illegal even if its under the W2 surgery center employee model.

If surgery center is hospital owned than surgeon can collect anesthesia profits. But since surgeon is part owner that creates a self referral and thus illegal.

We all know surgeons have less incentive to bring cases to centers they don't have an equity stake.

So what I am getting at is varying opinions

It is a kickback and they should go to prison.

 

[caligas]

Could somebody dumn this down for me? What is the issue exactly?

 

[BLADEMDA]

Could somebody dumn this down for me? What is the issue exactly?

http://www.anesthesiallc.com/public...in-before-you-pay-your-asc-for-the-franchise"

 

[BLADEMDA]

Proposed Arrangement A. The anesthesiologists would pay the physician-owned ASC a per-patient "Management Services" fee for each patient covering preoperative nursing assessments, space for the anesthesiologists and for the group's records in the ASC, and the transfer of billing information. The ASC would charge the group the fair-market value fee only for non-Medicare and other non-federal patients.

Proposed Arrangement B. The physician owners of the ASC would create subsidiary companies to furnish and bill for anesthesia services to patients. The subsidiaries would hire the anesthesiologists at a negotiated rate either as independent contractors or as employees of what were, in essence, shell companies. Anesthesia-related services that the group would contract to supply to the subsidiaries on an exclusive basis were:


Models A and B are illegal.

 

[caligas]

Excellent link/summary, thanks.

What if the anesthesia group agrees to "rent an office" at the ASC. A competing group in our town appearantly offered to do this and was able to pick up a choice contract for endo services. We lost out. I guess it would come down to whether or not the "rent" was consistant with market rates?

 

[BLADEMDA]

Excellent link/summary, thanks.

What if the anesthesia group agrees to "rent an office" at the ASC. A competing group in our town appearantly offered to do this and was able to pick up a choice contract for endo services. We lost out. I guess it would come down to whether or not the "rent" was consistant with market rates?

Correct. Market rates for the office space. If that group is paying exorbitant rates for that space then the AntiKickback Statute applies.

 

[aneftp]

My friend's pain practice is still going through the process of re organizing his anesthesia practice. In the past, he just hired a third party company to provide services. Than he had everything in house W2 billing.

He really doesn't care about the anesthesia money cause most of the time medicare doesn't pay for anesthesia anyways. Private insurance does still pay. But he just wanted full control over the anesthesia billing cause the third party anesthesia practices were sending his patients to collections and his patients were getting pissed.

Like I said, the attorney doesn't feel an in house W2 anesthesia model (with a physician owned facility) in which any anesthesia profits can go back to pain doc/gi doc/surgeon. My friend owns his own pain clinic (he's also anesthesiologist but practices pain 95% of the time).

It's all a wait and see at this time.

It's the Gi centers and some primary ortho surgery centers where anesthesia where anesthesia profits are ridiculous. Let's just say one of my friends makes $400K working 3 days a week at ortho center even with the shell company giving back 30% to the surgeons.