Comment on FR Doc # 2010-32705

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.