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Third Circuit Decides Stark Exception Case in Qui Tam Context

The Third Circuit Court of Appeals has rendered a provocative decision in the qui tam case, United States of America ex rel. Ted D. Kosenske, M.D. v. Carlisle HMA, Inc., which opinion was filed on January 21, 2009 and which is available at …

OIG issues another in a string of gainsharing opinions involving hospitals and groups of cardiologists and radiologists. This and the solicitation by HHS of comments on shared savings exceptions and safe harbors confirm HHS’s intent to continue to encourage legitimate cost savings and incentive programs.

Link: http://www.oig.hhs.gov/fraud/docs/advisorgopinions/2008/AdvOpn08-21.2.pdf.

Advisory Opinion 08-16, the text of which is linked below, involved a nonprofit hospital’s Pay for Performance (P4P) program with a commercial insurer and certain physicians on the hospital’s medical staff. Under the P4P program, the insurer pays the hospital bonus compensation calculated as percentage of the annual base compensation it otherwise pays to the …

The Department of Health and Human Services and Centers for Medicare and Medicaid Services (CMS) published final Stark IV regulations in the Federal Register on August 19, 2008. The web link is ttp://edocket.access.gpo.gov/2008/E8-17914.htm. The final regulations cover issues in addition to physician self-referral. Three issues of particular interest are the per-click compensation arrangements, the Stand-in-shoes regulations, …

Check David Harlow’s HealthBlawg ( http://healthblawg.typepad.com/) for a discussion of OIG Advisory Opinion 08-10, finding that a block leasing aggreement would be a prohibited joint venture.

STARK: "STAND IN SHOES" REGULATIONS

The original proposed physician "Stand in Shoes" regulations provide that any physician would stand in the shoes of any other doctor in the following circumstances:

1.      Another physician who employs the referring physician;

2.      His or her wholly owned professional corporation;

3.      A physician’s medical practice that employs or contracts with…

CMS recently modified its website to include a new page called Frequently Asked Questions and just added twelve questions and responses under the Physician Self-Referral page. Access the FAQs. at http://www.cms.hhs.gov/PhysicianSelfReferral/05a_FAQs.asp#TopOfPage.