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Path Lab Proposal Shot Down by OIG Print E-mail
Written by Jeffrey Cohen, Esq.   
Wednesday, 07 December 2011 12:52

The Office of Inspector General of the Department of Health and Human Services recently (October 11, 2011) shook its head at a proposal involving a pathology lab management services business that was to be owned by physicians. The proposed arrangement had the following features:

1. A path lab management business ("Manager") would be formed and the business would be owned by doctors;
2. The Manager would provide a list of management services to a path lab;
3. The path lab ("Lab") would not be owned by the doctors that own the Manager;
4. The Manager would provide a fixed amount of hours of services each year and would receive a percentage of the Lab's income (fixed percentage in advance) and that fee would approximate the Lab's use of the Manager's services for the year;
5. The physician Manager investors would be in a position to refer to the Lab;
6. The ownership interests of the physician investors in the Manager would exceed forty percent (40%);
7. More than forty percent (40%) of the Lab's revenues would come from the physician investors.

The OIG decided that the proposed arrangement posed more than a minimal risk of violating the Anti Kickback statute. The OIG also said the manager cannot refer its own patients or generate business in connection with the proposed arrangement. The OIG focused on the following points in its advisory opinion:

1. The Manager's "usage fees" to the Lab are percentage based and not flat and set in advance;
2. The ownership interests of the doctor investors in the Manager would exceed what is specified in the so called "small entity" Safe Harbor;
3. The physician owners of the Manager have no experience in managing a lab, but are in a position to generate referrals to it.

Though the regulatory Safe Harbors (to the Anti Kickback Statute) are illustrative of permissible arrangements, the OIG is clearly sticking very close to them. Where federal or state healthcare program dollars are involved, physician investors would do well to make sure they are Safe Harbor compliant.


ABOUT THE AUTHOR

With over 20 years of healthcare law experience following his position as legal counsel for the Florida Medical Association, Mr. Cohen is board certified by The Florida Bar as a specialist in healthcare law. His practice immerses him in regulatory, contract, corporate, compliance and employment related matters. Mr. Cohen is the founder of The Florida Healthcare Law Firm.
www.floridahealthcarelawfirm.com | 888-455-7702
Last Updated on Wednesday, 07 December 2011 13:01
 
N.E. Florida's Largest Hospitals, Group Practices Announced Print E-mail
Written by Jeffrey Herschler   
Wednesday, 16 November 2011 12:09

NEWS YOU CAN USE 

According to the Jacksonville Business Journal, NE Florida's largest hospitals are Shands Jacksonville with 695 licensed beds followed by Baptist Medical Center Jacksonville/Wolfson Children's Hospital (619 beds) and Northeast Florida State Hospital (613 beds). Top Group Practices in the area are University of Florida Jacksonville Physicians, with 414 doctors and 1,520 support staff, Mayo Clinic Hospital (369 doctors and 1,096 support staff) and Baptist Primary Care (172 doctors and 650 support staff).

Meanwhile back in South Florida, Alice Taylor has been named Chief Executive Officer of Broward Health Imperial Point Medical Center

PRESENTED BY MF HEALTHCARE SOLUTIONS

 
Trends in Employer Healthcare Costs Print E-mail
Written by Michael Newhouse   
Thursday, 03 November 2011 09:06

NEWS YOU CAN USE

Employer healthcare costs are expected to increase in 2012 at the lowest rate in more than a decade at 5.4%, but employee cost of benefits is likely to outpace the growth of their earnings. The smaller increase reflects cost-cutting efforts by employers. Many are moving workers into lower-cost health plans or slashing expenses by raising insurance deductibles. In the absence of any cost-cutting, employers said they expect their average health benefit costs to rise 7.1%. That is down from about 9% each of the last five years, according to William M. Mercer & Co.
Last Updated on Saturday, 12 November 2011 16:40
 
Who pays for healthcare in U.S.? Print E-mail
Written by Jeffrey Herschler   
Friday, 21 October 2011 09:29

Every Picture Tells a Story

 Payors Share of U.S. Healthcare Bill

America's privately-financed private health insurance companies pay a small a share of the nation's healthcare bill.   See Related Story:  America's Health Insurance Myth

Presented by MF Healthcare Solutions
 
Compensation Committee from Hell? Print E-mail
Written by Jeffrey Herschler   
Thursday, 20 October 2011 07:12

The Joint Committee on Deficit Reduction plans to closely examine entitlement programs like Medicare and Medicaid as it attempts to resolve the nation's long term budget gap.  Reimbursements paid by these programs will be under the microscope.  Click on the link below to view pics of your favorite legislators:

 National Debt Super Committee - Money.CNN.com

Senate Dem's include ,  Patty Murray, Washington, Co-Chair, Max Baucus, Montana and  John Kerry, Massachusetts.  Senate Pub's are Jon Kyl, Arizona, Rob Portman, Ohio and Pat Toomey, Pennsylvania. House leaders serving on the committee are Dem's Xavier Becerra, California,  Jim Clyburn, South Carolina and Chris Van Hollen, Maryland and Pub's Jeb Hensarling, Texas, Co-Chair, Fred Upton, Michigan and Dave Camp, Michigan.

Don't expect the healthcare community to go down without a fight.  For example, see below for latest posting on the MGMA website:

Joint Committee announces first public hearing, contact lawmakers now to repeal SGR!
The new Joint Committee on Deficit Reduction held its first operational meeting Thursday, Sep. 8, followed by its first public hearing Tuesday, Sep. 13. The 12-member bipartisan committee is tasked with proposing at least $1.2 trillion in debt reduction by Nov. 23, which Congress must vote on by Dec. 23.  MGMA urges members to call on the Joint Committee and Congress to address the flawed sustainable growth rate (SGR) and avert the 29.5 percent Medicare physician payment cut scheduled for Jan. 1, 2012. The Joint Committee process may be the best upcoming opportunity to repeal the SGR, as budget offsets for SGR repeal will be in short supply after the Joint Committee completes its work. Visit the MGMA Advocacy Center to get involved and voice your concerns. 


Meanwhile, according to Modern Healthcare, the U.S. House of Representatives has recently reignited its SGR Repeal rally and is also promoting the concept of the Joint Committee as a conduit for change: 

"A 'dear colleagues' letter that was circulated in the U.S. House of Representatives urging repeal of the sustainable growth-rate formula for Medicare payments to physicians garnered 114 signatures before being sent on to the Joint Select Committee on Deficit Reduction." 

Learn More 

View Video:  Deb committee's job:  Fix everything

Last Updated on Wednesday, 26 October 2011 16:36
 
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