Outpatient Surgery Magazine - Subscribers

OR Excellence Awards 2015 - September 2015 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/567827

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Page 44 of 168

4 5 S E P T E M B E R 2 0 1 5 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E lab may be engaging in illegal remuneration. Why would a lab waive its charges for services rendered? Simply put, it allows one-stop shopping for gastro practices. The multi-region- al medical laboratory that requested the OIG's opinion proposed to enter into exclusive contracts with physician practices and provide all of their necessary clinical lab and pathology services, unless patients opted to obtain the services from a different company. The lab explained that some practices prefer to work with a single lab, as it enables easier communication and consistency in the reporting of results. Under this proposal, physicians would agree to refer all of their lab testing to the contracted lab, and the lab would submit the claims for all referred patients to the insurance plans in which the lab participates, including Medicare and Medicaid. However, the lab noted, some patients are covered by insurance plans that designate different labs as exclusive providers and don't permit patients to go out of network. In these cases, the lab would not charge the patients. The agreement between the lab and the practices it served would include a statement by the physicians attesting that they are not receiving benefits of any kind in exchange for referring patients to the lab, and that patients would be given a choice of labs in order to avoid the appearance of patient steering. That statement, however, did not dispel the OIG's suspicions. Its advisory opinion finds the proposed exclusive arrangements problem- atic because through them the lab provides free services for certain patients in order to secure all of the business from physician prac- tices, including their federal healthcare program business. The OIG has long regarded the provision of free or below-market- value services to referral sources as suspect and potentially in viola- tion of the Anti-Kickback Statute. In this instance, physicians would

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