Outpatient Surgery Magazine

OR Excellence Awards 2015 - September 2015 - Subscribe to Outpatient Surgery Magazine

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

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4 6 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 | S E P T E M B E R 2 0 1 5 be receiving indirect remuneration due to the efficiencies of using a single lab for all their service needs, and could also benefit by not hav- ing to pay maintenance fees for interfaces with multiple labs. In addition, the OIG's opinion sees the proposed arrangements as a potential violation of the "substantially in excess" provisions of the Social Security Act, which can result in the exclusion of providers from Medicare and Medicaid. The purpose of the "substantially in excess" provisions is to prevent healthcare providers from charging the Medicare and Medicaid programs more than the provider typically charges other payers. To evaluate if a provider is charging federally-funded programs "sub- stantially in excess" of its usual charges, the OIG typically seeks to determine if the provider is discounting close to half of its non- Medicare and Medicaid business. In the proposed exclusive arrange- ments that were the subject of the advisory opinion, the OIG deter- mined that this was a plausible outcome. Take caution in contracts A few precautions can help to keep gastroenterology practices' and endoscopy centers' pathology billing arrangements above board and out of regulators' Anti-Kickback Statute scrutiny. First, when entering into exclusive contracts with secondary providers, avoid including such conditions as the systematic waiver or reduction of fees for services to certain classes of patients, or provi- sions that call for payments to be made from the secondary provider L E G A L U P D A T E The OIG has long regarded the provision of free or below-market-value services to referral sources as suspect and potentially in violation of the Anti-Kickback Statute.

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