Here’s How Practice Groups Can Refer Patients to Hospital to Make Profit

June 27th, 2016 by haber Leave a reply »

Mr. Haber is a former Assistant United States Attorney and former Senior Attorney for the Office of Inspector General – United States Department of Health and Human Services.  After leaving federal service, Mr. Haber founded this firm in 1984, and has been servicing healthcare practitioners ever since.

What most practice groups and hospitals are unaware of, the Office of Inspector General [OIG], one of this author’s prior employers, is empowered by Congress to issue Advisory Opinions. To the degree that all material facts are provided and there are no deviations from them in implementation, the Requestors can rely upon these OIG Advisory Opinions in their practices. This includes arrangements that would otherwise be considered improper and violations of the applicable statutes, except for safeguards instituted by the Requestors and approved by the OIG, so as to avoid any material incentive for overutilization, patient abuse or program fraud. These Advisory Opinions are only binding as to the specific Requestors. While they might be time consuming and expensive to prepare and submit, they can be extremely rewarding financially and professionally for the Requestors. An experienced Healthcare Attorney, like those at the Law Office of Kenneth Joel Haber, P.C., [tel. 301-670-0016] can assist in obtaining such an OIG Advisory Opinion. Also, privately written Healthcare Attorney legal opinions are also available through this firm. There exist differences between these two types of opinions and you can call this office to speak to a Healthcare Attorney in order to learn the differences. As it is said in healthcare, if it is not in writing it does not exist.

This particular OIG Advisory Opinion was issued to a Hospital and three practice groups pertaining to cost savings measures in certain cardiac catheterization procedures [the “Arrangement”]. The practice groups were a Cardiology Group, an Interventional Radiology Group, and a Vascular Surgical Group. The Hospital engaged a “Program Administrator” to administer the Arrangement. The Program Administrator identified 21 areas of cost saving recommendations that were identified in an Executive Summary.

The Executive Summary identified the twenty-one specific recommendations that can be grouped roughly by category of product standardization. The Executive Summary recommended that the Groups change current cardiac catheterization procedures to standardize the types of cardiac catheterization devices and supplies (stents, balloons, interventional guide wires and catheters, vascular closure devices, diagnostic devices, pacemakers, defibrillators, etc.) they employ. The Groups were required to work in conjunction with the Hospital to evaluate and clinically review vendors and products. The Requestors have certified that they selected the preferred products eligible for payments under the Arrangement based on a process that first considered whether the products were clinically safe and effective. An assessment was then made whether the proposed standardization measures were appropriate on the basis of clinical criteria.

Various safeguards were instituted including statistical analysis of clinical results and the ultimate freedom of choice by the clinicians and patients based upon individual patient’s medical needs. Various safeguards were put into place as to the Program Administrator and ultimately the Office of Inspector General concluded that legitimate cost-savings could be made and shared without risk to patient care or risk to the financial well-being of the Medicare Program.

After coming to that conclusion, the Office of Inspector General issued the specific Advisory Opinion that permits the sharing of the cost savings with the respective Physicians Groups without risk of sanctions, even though the Physician Groups or Hospital might arrange referrals to each other. While such an approval process can take time and a substantial amount of work to complete, it can be substantially rewarding financially and otherwise beneficial to all concerned. Much has been said about Propecia (Finasteride). I want to highlight a few important points about the way of its admission. You should take one pill once a day regardless of the meal time. Changing the drug dose without physician approval is strictly prohibited. In the pursuit of a quick action, somepatients ignore this rule, as a result of which they experience its side effects: slight malady; vertigo; headache.

This same process can be utilized to save money in other areas of a physician group’s, hospital’s or medical center’s service programs and the savings shared with the physicians who are the often unappreciated, often vilified front line of our healthcare system. These issues are the subject matters for an experienced Healthcare Attorney and not for amateurs. The same applies to private Healthcare Attorney opinion letters.

As always, please feel free to contact this firm regarding this article or any other healthcare issue or for a no obligation initial consultation. You may initiate the consultation through the comment box by leaving your telephone number or by calling the firm at 301-670-0016 and asking for Kenneth Haber. Thank you and do not forget to refer us to a colleague if you find this information helpful.


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