OIG advisory opinions ASCs need to know

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Over the past decade, the HHS Office of Inspector General has issued several warnings of potential fraud and abuse risks with physician-owned distributorships, which often include ASCs. 

More recently, however, the OIG issued a favorable opinion approving an ASC arrangement after kickback concerns.

Here is a breakdown of several OIG opinions over the past decade that affected ASCs:

2021:

  • In April, the OIG issued a favorable opinion approving a joint-venture ASC arrangement between physicians, a management company and a health system. The venture was being investigated for its potential to break federal anti-kickback laws.

2013:

  • The OIG issued a special fraud alert in 2013 addressing physician-owned distributorships, focusing on the specific attributes it believes produce fraud and abuse risk through physician referrals.

2012:

  • The OIG outlined two proposed arrangements between anesthesiologists and physician-owned facilities that could lead to sanctions.
  • OIG Advisory Opinion 12-22 approved a co-management arrangement between a hospital and a cardiology group. The cardiology group agreed to provide management and medical director services to the hospital's cardiac catheterization laboratories in exchange for compensation that included a performance bonus. 
  • OIG Advisory Opinion 12-15 involved a per diem call coverage arrangement between hospitals and physicians. The OIG approved the proposed call coverage arrangement, but did articulate concerns with covert kickbacks in call payments. 
  • OIG Advisory Opinion 12-01 offered guidance on a group purchasing organization formed to service a variety of healthcare organizations, facilities and providers. The underlying question was whether the vendors are providing a kickback to induce the GPO to buy their products. The OIG concluded that the proposed arrangement presented an acceptable level of fraud and abuse risk. 
  • OIG Advisory Opinion 12-10 approved a proposal by a radiology group to offer free insurance preauthorization services to physicians and patients using the requestor's radiology services. The OIG approved the proposed arrangement based upon the existence of legitimate business interests and various safeguards.
  • OIG Advisory Opinion 12-08 approved of a situation where an independent diagnostic testing facility proposed to hire a physician to read and interpret test results. 

Read more about the 2012 OIG rulings here

2011:

  • A 2011 congressional report was released that said "the very nature of PODs seem to create financial incentives for physician investors to use those devices that give them the greatest financial return and that, in the process, patient treatment decisions may be based on personal financial gain."

 

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