Medicare Compliance & Reimbursement
MULTI-SPECIALTY PRACTICE FOUNDERS WITH ASC PROPOSAL
While recent advisory opinions suggest that there’s at least a little bit of wiggle room when it comes to skirting kickback issues arising out of hospital-medical group joint ownership of ambulatory surgical centers, ownership deals that drift too far from the hospital-physician ASC safe harbor are liable to founder.
That’s what happened to the proposal scrutinized in the HHS Office of Inspector General’s latest advisory opinion (No. 03-5). Under the proposal, the ASC would be jointly owned by a hospital and a multi-specialty physician group. The problem centered on the fact that the group included doctors from a wide range of specialties. Safe harbor protection is generally available only to physician- investors who either use the ASC routinely or who practice in the same specialty as other physician- investors.
In the deal under review, however, since the group “is a multi-specialty group, there is a substantial likelihood of cross-specialty referrals for services performed in the ASC,” the OIG maintains.
That means that group physicians who don’t use the ASC could still profit from their referrals to the ASC, or to the physicians who provide services there — which in turn raises the prospect that the ASC joint venture could be used to reward referrals, an anti-kickback no-no.
To see the opinion, go to http://oig.hhs.gov/fraud/docs/advisoryopinions/2003/ao0305.pdf.
Medicare Compliance & Reimbursement
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