4 7
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
to the practice or center.
While an ideal exclusive arrangement with a lab would require the
lab to participate in all payer programs with which the practice or
center participates, this is not always practical or possible. At a mini-
mum, there should be an understanding between the 2 parties that the
lab will make some effort to seek payment for the services it renders
to all the patients of the practice or center.
The OIG's advisory opinion also cautions providers to be mindful
of the fees actually charged to private insurance patients, in order
to avoid a situation in which the fees charged to Medicare and
Medicaid patients are "substantially in excess" of those charged to
third-party payers. While "substantially in excess" charges against
practices and centers are rare, the penalties for overcharging feder-
ally funded programs in comparison to the facility's usual and cus-
tomary charges are severe.
Gastro practices and endo centers should always exercise caution
in awarding exclusive contracts to secondary providers such as lab
service companies. Before entering into any such exclusive agree-
ment, physicians and facility administrators should consult with
their legal counsel or an attorney who is experienced in healthcare
and business laws and regulations. OSM
Mr. Fanburg (jfanburg@bracheichler.com) chairs the health law practice at Brach Eichler in Roseland, N.J.
