Becker's ASC Review

13 ASC MANAGEMENT OIG advisory opinions ASCs need to know By Patsy Newitt O ver the past decade, the HHS Office of Inspector General has issued several warnings of potential fraud and abuse risks with physician-owned dis- tributorships, which oen include ASCs. is year, however, the OIG issued a favor- able opinion approving an ASC arrangement aer kickback concerns. Here is a breakdown of several OIG opin- ions over the past decade that affected ASCs: 2021: • In April, the OIG issued a favorable opinion approving a joint-venture ASC arrangement between physicians, a management com- pany and a health system. e venture was being investigated for its potential to break federal anti-kickback laws. 2013: • e OIG issued a special fraud alert in 2013 addressing physician-owned distribu- torships, focusing on the specific attributes it believes produce fraud and abuse risk through physician referrals. 2012: • e OIG outlined two proposed arrange- ments between anesthesiologists and physician-owned facilities that could lead to sanctions. • OIG Advisory Opinion 12-22 approved a co-management arrangement between a hospital and a cardiology group. e car- diology group agreed to provide manage- ment and medical director services to the hospital's cardiac catheterization labora- tories in exchange for compensation that included a performance bonus. • OIG Advisory Opinion 12-15 involved a per diem call coverage arrangement between hospitals and physicians. e OIG approved the proposed call coverage arrangement, but did articulate concerns with covert kickbacks in call payments. • OIG Advisory Opinion 12-01 offered guid- ance on a group purchasing organization formed to service a variety of healthcare organizations, facilities and providers. e underlying question was whether the vendors are providing a kickback to induce the GPO to buy their products. e OIG concluded that the proposed arrangement presented an acceptable level of fraud and abuse risk. • OIG Advisory Opinion 12-10 approved a proposal by a radiology group to offer free insurance preauthorization services to physicians and patients using the request- or's radiology services. e OIG approved the proposed arrangement based upon the existence of legitimate business interests and various safeguards. • OIG Advisory Opinion 12-08 approved of a situation where an independent diagnos- tic testing facility proposed to hire a physi- cian to read and interpret test results. 2011: • A 2011 congressional report was released that said "the very nature of PODs seem to create financial incentives for physician in- vestors to use those devices that give them the greatest financial return and that, in the process, patient treatment decisions may be based on personal financial gain." n Comprehensive Surgical Care breaks ground on 3rd ASC in $125M expansion By Patsy Newitt G ilbert, Ariz.-based Comprehensive Surgical Care began construction on an ASC in Flagstaff, Ariz., its third in the state, according to an email from the company. The multispecialty ASC is a part of CSC's 20- ASC, $125 million expansion planned over the next two years. The 8,100-square-foot center will feature two operating rooms, two presurgery rooms, three postanesthesia care unit beds, four exam rooms, two bariatric rooms and an ultrasound room. The ASC will be certified by the Accredita- tion Association for Ambulatory Health Care, according to the email. n 23-clinic pain practice in California closes without explanation By Laura Dyrda A chain of pain management clinics suddenly shut its doors May 14, according to The Modesto Bee. Lags Medical Centers, which has 23 California locations, didn't provide much warning before closing down, according to the report. At least one former staff member told The Bee she was surprised by the closure. Stephanie Bjorge, a former patient at one of the clinic's locations in Modesto, Calif., told The Bee that a nurse practitioner texted her about the closure May 13 and said it would provide one month's supply of her pain medications. "The next closest option for me is San Francisco," she said. "There are no other options. There is nothing for us in the valley. This is cata- strophic for us." Lags Medical Centers also has locations in Nevada, Florida and Delaware. Its California locations and physicians have experienced past issues. CMS terminated provider status for Oxnard-based Lags Surgery Center in 2018 for failing to meet regulatory requirements. A year earlier, Ed Balbas, MD, was convicted of insurance fraud. n

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