An attorney with HHS' Office of Inspector General said Thursday that the OIG is hiring additional lawyers to look into taking more administrative actions against doctors. They're looking for the types of questionable payment arrangements addressed in an OIG fraud alert issued earlier this week.
The alert warned doctors entering into compensation arrangements, such as medical directorships, that their pay must be in line with fair market value for services provided. It's common for doctors to be employed by hospitals and other organizations as medical directors, but those arrangements can violate the anti-kickback law when they're intended to get more referrals from those doctors, according to the alert.
The anti-kickback law prohibits the exchange of money for referrals involving federal healthcare dollars.
Kevin Barry, deputy chief in the Administrative and Civil Remedies Branch in the Office of Counsel to the Inspector General, said even the addition of a few attorneys to look at such cases is helpful following years of a hiring freeze. Barry spoke at the American Bar Association Health Law Section's Physicians Legal Issues Conference in Chicago.
A number of legal experts agree that the alert, issued Tuesday, could signal that the feds plan to increasingly pursue allegations against individual doctors, rather than just the organizations that pay them.
“The OIG's going to start focusing on physicians,” said Adrienne Dresevic, an attorney with The Health Law Partners, at the conference. “This OIG alert is basically (directed at) the physician community.”
The alert follows settlements reached between the OIG and 12 individual physicians in recent years who entered into “questionable” medical directorship and office staff arrangements, according to the OIG.
The settlements appear to have been with doctors accused of receiving kickbacks through medical director and/or referral coordinator agreements with Houston imaging facility Fairmont Diagnostic Center and Open MRI. Attempts to reach Fairmont for comment earlier this week were unsuccessful, but under at least one of those settlement agreements it was excluded from doing business with federal programs for six years.
Other topics discussed at the conference Wednesday and Thursday included the False Claims Act, the anti-kickback statute, fraud and the Stark law. A number of prominent leaders from the OIG, CMS and U.S. Department of Justice shared their thoughts.
Shantanu Agrawal, deputy administrator and director with CMS's Center for Program Integrity, said waste accounts for about 30% of overall healthcare costs. He said this waste includes a spectrum of issues ranging from coding mistakes to outright fraud.
The CMS works to reduce such spending in a number of ways, including by sending providers comparative billing reports, which shows how their billing and payment patterns compare with their peers on both the state and national levels. Sometimes, those reports are enough for physicians to change their behavior, he said.
Agrawal also said the CMS is working with behavioral scientists to see if talking with physicians, by phone or in-person, about billing issues, as opposed to auditing them, is effective.
Early data suggests that approach could work, he said, with many physicians changing their behavior.
Instead of an audit, “we could use something a lot softer that didn't require the return of money but instead elicited what we really wanted … compliance.”
Agrawal said more data on how to approach these issues is expected later this month, but would not elaborate further. The conference was presented in conjunction with the Chicago Medical Society and the American Association for Physician Leadership.
