As an anesthesiologist, I am submitting comments in response to the OIG solicitation
for Special Fraud Alerts. I firmly believe that the “company model” is an appropriate
issue for such an alert.
Under the company model, the referring physicians, who typically also own the
facility performing the surgical procedure, form a separate anesthesia company that
they own. Establishment of a separate anesthesia company permits the facility to bill
for facility fees and anesthesia services fees through the same billing/administrative
company. Owners of the facility and the anesthesia company then share in the
profits generated by the facility fees and the anesthesia service fees.
This company model implicates a number of the specified criteria the OIG considers
when issuing Special Fraud Alerts, including:
1. Decreasing the quality of services through incentives for referring physicians to
demand administration of inappropriate anesthesia services.
2. Decreasing competition among health care providers due to a lack of legal
guidance from OIG thus creating an environment where only the groups or
individuals willing to assume the substantial legal risk of accepting this model will
remain economically viable.
3. Increasing the potential overutilization of the health care services through
referring physician pressures to anesthesia providers to administer inappropriate
anesthesia services or deeper levels of sedation than is medically necessary in order
to maximize profits.
4. Increasing the cost to Federal health care programs through the increased
pressure to maximize utilization of anesthesia services and the increasing number of
procedures provided in ASCs to Medicare beneficiaries.
For these reasons, we strongly encourage the OIG to issue a Special Fraud Alert
providing guidance to the physician and provider community on the legality of this
economic model. We appreciate your consideration of this important matter.
Comment on FR Doc # 2010-32705
This is comment on Proposed Rule
Solicitation of New Safe Harbors and Special Fraud Alerts
View Comment
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