Becker's Spine Review

55 ASC ASCs, hospitals pay millions as scrutiny intensifies for illegal referrals By Laura Dyrda T he U.S. Justice Department is putting hospitals, ASCs and physician groups under the microscope, in search of improper relationships that violate anti-kickback laws, which could have big consequences for the industry. Seven lawsuits and settlements in the last year, with combined payments topping $55 million: 1. Akron (Ohio) General Health System agreed to pay $21 mil- lion to settle allegations that it made improper payments to physicians for referrals from 2010 to 2016, according to a July 2 statement from the Justice Department. Aer the system was acquired by Cleveland Clinic in 2015, it voluntarily disclosed an alleged improper financial relationship with physician groups. 2. Surgical Care Affiliates, based in Deerfield, Ill., and Orlando Center for Outpatient Surgery, agreed to pay $3.4 million in June to settle allegations of paying kickbacks for referrals related to kidney stone procedures. A whistleblower lawsuit alleged the center paid urologist Patrick Hunter, MD, pre-procedure pay- ments for his lithotripsy procedures. Dr. Hunter's estate sepa- rately paid $1.75 million to resolve the allegations. 3. In April, three Ascension-affiliated hospitals in Texas agreed to pay $20.9 million to resolve allegations that they paid physi- cians above market value for services, including on-call coverage and administrative oversight of specialty programs. 4. Ashok Kumar, MD, paid $215,228 to settle allegations he ac- cepted kickbacks in exchange for referring patients to Memorial Hospital of Gardena (Calif.) in March. Other defendants in the lawsuit paid an $8.1 million settlement in 2018 to resolve claims that the hospital paid above market value to induce referrals. 5. Collier Anesthesia Pain in Fort Myers, Fla., and Tampa (Fla.) Pain Relief Clinic agreed to pay $1.6 million to resolve accusa- tions that they violated anti-kickback statutes in February. e two groups were accused of sending patients for surgery at ASCs where copayments were waived and submitting improper claims for ancillary tests and services. 6. Bismarck, N.D.-based Mid Dakota Clinic paid $5.5 million to settle allegations of an improper financial arrangement with its wholly owned ASC in October 2020. A whistleblower lawsuit alleged the clinic's physicians could make or influence referrals to the ASC and gather revenue. 7. Advanced Pain Management in Greenfield, Wis., paid $1 mil- lion to settle allegations in October 2020 that the company pro- vided stock incentives to nonemployed physicians to perform procedures at its ASCs and in some cases paid nonemployee physicians to be medical directors. n 10 of the largest ASC chains in the US | 2021 By Laura Dyrda Many of the largest ASC chains in the U.S. grew last year during the pandemic. Here is where 10 companies stand with the number of ASCs in their network as of June 2021. 1. United Surgical Partners International (Dallas): 312 2. AmSurg (Nashville, Tenn.): 250+ 3. Surgical Care Affiliates (Deerfield, Ill.): 250+ 4. HCA Healthcare (Nashville, Tenn.): 142 5. Surgery Partners (Brentwood, Tenn.): 109 6. SurgCenter Development (Towson, Md.): 92 7. PE GI Solutions (Jamison, Pa.): 60+ 8. ValueHealth (Leawood, Kan.): 50+ 9. Covenant Physician Partners (Nashville, Tenn.): 48 10. Regent Surgical Health (Chicago and Nashville, Tenn.): 22 Last year, USPI and SCA added more than 1,000 physicians to their ASC networks and have plans to add thousands more this year. The companies also are partnering with health systems to expand their networks. n New Jersey ASC debuts spine robot By Carly Behm W est Orange, N.J.-based Advanced Spine and Outpatient Surgery debuted the ExcelsiusGPS robotic navigation system, according to a July 21 news release. Praveen Kadimcherla, MD, and Kaixuan Liu, MD, performed the spinal fusion on a 57-year-old patient who had a col- lapsed disc in his lower back and a bone spur impinging on a sciatic nerve. The Excelsius GPS robot created images of the patient's spine and guided surgeons during the procedure. Insert- ing screws in the patient's spine, which typically takes one hour, took 10 minutes using the robotic guidance. Advanced Spine and Outpatient Surgery is part of West Orange-based Atlantic Spine Center. n

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