Bass, Berry & Sims attorney Bill Mathias provided insight for an article examining a recent settlement between a hospital and the Department of Health and Human Services Office of Inspector General (HHS-OIG) regarding allegations the hospital paid kickbacks to certain physicians in the form of free advanced practice provider (APP) services. The settlement is the latest in a series of matters where the government has questioned these types of arrangements between hospitals or independent physicians.
“Whose benefit is in the eye of the beholder,” said Bill. “The government says, ‘You’re just doing it to secure the referrals of surgeons,’ and the hospital says, ‘We are doing it for six good reasons.’ That’s where it gets complicated.”
As these arrangements have come under heightened scrutiny recently, Bill recommends that hospitals “include the use of APPs on their hospital’s risk assessment.” He added, “You can design these arrangements in a way you feel comfortable, but sometimes they go off the rails as they get implemented.” For example, “an APP will want to do more, and the physician will start to do less. Are we trying to thread a needle we know isn’t going to happen in practice?”
The full article, “Hospital Pays $3M in CMP Settlement Over APP Services; Benefits ‘Are in Eye of Beholder’” was published in the Report on Medicare Compliance on August 19 and is available online.
Bill will also be speaking on this topic at the American Health Law Association’s Fraud & Compliance Forum in October. The panel is entitled “Conundrum of NPs, PAs, and Other APPs – Valuable Resource, But Care Needed in Structure, Communication, and Operation to Mitigate F&A Risk.”