jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Thu May 01, 2003 5:17 am Post subject: Homehemo/Anti-Kickback Law
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April 30, 2003 - Upon close examination, the Special Advisory Bulletin on contractual joint ventures from the HHS Office of the Inspector General (OIG) contains a reference to home dialysis care:<
>An "example of potentially problematic contractual arrangements include the following:"<
>"A group of nephrologists establishes a wholly-owned company to provide home dialysis supplies to their dialysis patients. The new company contracts with an existing supplier of home dialysis supplies to operate the new company and provide all goods and services to the new company."<
>"These problematic arrangements typically exhibit certain common elements. First, the Owner expands into a related line of business, which is dependent on referrals from, or other business generated by, the Owner?s existing business. The new business line may be organized as a part of the existing entity or as a separate subsidiary. Typically, the new business primarily serves the Owner?s existing patient base.<
>Second, the Owner neither operates the new business itself nor commits substantial financial, capital, or human resources to the venture. Instead, it contracts out substantially all the operations of the new business. The Manager/Supplier typically agrees to provide not only management services, but also a range of other services, such as the inventory necessary to run the business, office and health care personnel, billing support, and space. While the Manager/Supplier essentially operates the business, the billing of insurers and patients is done in the name of the Owner. In many cases, the contractual arrangements result in either practical or legal exclusivity for the Manager/Supplier through inclusion of non-competition provisions or restrictions on access. While the contract terms of these arrangements may appear to place the Owner at financial risk, the Owner?s actual business risk is minimal because of the Owner?s ability to influence substantial referrals to the new business.<
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>Third, the Manager/Supplier is an established provider of the same services as the Owner?s new line of business. In other words, absent the contractual arrangement, the Manager/Supplier would be a competitor of the new line of business, providing items and services in its own right, billing insurers and patients in its own name, and collecting reimbursement.<
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>Fourth, the Owner and the Manager/Supplier share in the economic benefit of the Owner?s new business. The Manager/Supplier takes its share in the form of payments under the various contracts with the Owner; the Owner receives its share in the form of the residual profit from the new business.<
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>Fifth, aggregate payments to the Manager/Supplier typically vary with the value or volume of business generated for the new business by the Owner. While in some arrangements certain payments are fixed (for example, the management fee), other payments, such as payments for goods and services supplied by the Manager/Supplier, will vary based on the number of goods and services provided. In other words, the aggregate payment to the Manager/Supplier from the whole arrangement will vary with referrals from the Owner. Likewise, the Owner?s payments, that is, the difference between the net revenues from the new business and its expenses (including payments to the Manager/Supplier), also vary based on the Owner?s referrals to the new business. Through these contractual payments, the parties are able to share the profits of the new line of business."<
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>Please read the entire advisory for a complete and thorough explanation and to view all associated footnotes.<
>April 29, 2003 - There have been several recent advisory opinions provided by the Health & Human Services (HHS) Office of the Inspector General (OIG).<
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>SUSPECT CONTRACTUAL JOINT VENTURES<
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>On April 23, the OIG issued a special advisory bulletin that cautions health care providers serving Medicare and Medicaid beneficiaries against entering into joint venture arrangements that reward the provider for improper patient referrals in violation of the federal anti-kickback statute. Press release from the HHS OIG (pdf format).<
>CONTRACTUAL JOINT VENTURES - Special Advisory Bulletin from the HHS OIG (pdf format).<
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bean counter
Joined: 03 May 2003
Posts: 1
Posted: Sat May 03, 2003 6:04 am Post subject: Looks promising
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The gvt is getting wise?
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Wed May 14, 2003 3:51 pm Post subject: Re: Looks promising
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Looks like the government is finally taking notice!!! This is essentially the same wording for the majority of contracts in a physician's office for lab services, dictation services, insurance billing, etc. About d--- time!!!
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Thu May 15, 2003 12:07 am Post subject: Yes, it's' about time!!!
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It shouldn't be allowed to happen; the fact that it's mostly tax payer dollars makes me want to retch! Lin.
