Category Archives: Self-Referral

Health Care Provider – Vendor Agreements: Have you looked at them lately?

Posted on March 9, 2012 by | Comments Off

Health care providers enter into agreements with vendors on a daily basis. Providers have agreements with suppliers for items and services, such as – durable medical equipment, medical supplies, EKG/Holter monitoring services and pharmaceuticals. Providers also have agreements with ancillary providers, like rehabilitation therapists, audiologists, psychologists, wound care professionals, and others.

Entering into and working with these types of agreements and arrangements can and does become a routine function of any provider. Often when providers treat these agreements as a routine day to day function, important compliance and business related concerns can get overlooked. An important element of the compliance function of any provider organization should include a periodic review of its vendor agreements and arrangements. Continue reading →

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Posted in Anti-Kackback, Compliance Programs, Exclusion, Fraud and Abuse, Health & Human Services, Health Care, Health Care Providers, HIPAA, Medicaid, Medicare, OIG, Regulatory Compliance, Self-Referral

Final Rule on Expansion of Physician-Owned Hospitals under the Stark Physicians Self Referral Rule

Posted on November 21, 2011 by | Comments Off

On November 1, 2010, the Centers for Medicare and Medicaid Services (“CMS”) released the final rule governing the procedures and requirements by which a physician-owned hospital may apply for an exception to the Stark Physician Self Referral Law’s prohibition against expanding a physician-owned hospital’s capacity. The rule, effective on January 1, 2012, will be published in the Federal Register on November 30, 2011. Continue reading →

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Posted in Acute Care, Final Rule, Fraud and Abuse, Health Care Providers, Hospital, Physicians, Regulation, Self-Referral

OIG Enters into $7.3 Million Settlement and Corporate Integrity Agreement with Lithotripsy Physicians and Related Entities

Posted on July 9, 2010 by | Comments Off

On July 8, 2010, the OIG released a press release announcing that it entered into a 7.3 million dollar civil monetary penalty (“CMP”) settlement agreement with United Shockwave Services, United Prostate Centers, and United Urology Centers (the “Settlement Parties”), all based in the Chicago, Illinois area. The agreement settles charges that, by soliciting and receiving payments from hospitals in exchange for patient referrals, the Settlement Parties violated Federal anti-kickback laws. Continue reading →

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Posted in Acute Care, Anti-Kackback, Civil Litigation, Corporate Integrity Agreements, Fraud and Abuse, Hospital, Illinois, Medicare, OIG, Out-Patient Care, Physicians, Self-Referral, Settlements

OIG Enters into $7.3 Million Settlement and Corporate Integrity Agreement with Lithotripsy Physicians and Related Entities

Posted on July 9, 2010 by | Comments Off

On July 8, 2010, the OIG released a press release announcing that it entered into a 7.3 million dollar civil monetary penalty (“CMP”) settlement agreement with United Shockwave Services, United Prostate Centers, and United Urology Centers (the “Settlement Parties”), all based in the Chicago, Illinois area. The agreement settles charges that, by soliciting and receiving payments from hospitals in exchange for patient referrals, the Settlement Parties violated Federal anti-kickback laws. The OIG alleged that the Settlement Parties and certain of its physician-owners, leveraged patient referrals to obtain contract business from hospitals in Illinois, Indiana, and Iowa. OIG also alleged that Settlement Parties caused certain hospitals to submit claims for designated health services that resulted from prohibited referrals in violation of the Physician Self-Referral Law (the “Stark law”).

Under the 5-year Corporate Integrity Agreement, the Settlement Parties are required to hire an Independent Review Organization. The independent reviewer will monitor lithotripsy and laser arrangements between them and any hospital in Illinois, Iowa, and Indiana that receives referrals from them or their physician investors. The Settlement Parties are also required to create a comprehensive training program to educate employees and corporate members on Stark law and kickback issues.

In resolving the matter through a settlement agreement, the Settlement Parties have denied any liability.

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Posted in Acute Care, Civil Litigation, Fraud and Abuse, Health Care, Health Care Providers, Hospital, Illinois, Iowa, OIG, Out-Patient Care, Physicians, Self-Referral

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