6
ASC Management
T
he following hospitals, health systems and healthcare companies en-
tered into settlement agreements to resolve alleged violations of the
False Claims Act and Stark Law since January.
1. Calif. hospital to pay $3.2M to r esolve Stark Law allegations.
Tri-City Medical Center, a 397-bed hospital in Oceanside, Calif., agreed to
pay the federal government more than $3.2 million to resolve allegations it
violated Stark Law and the False Claims Act.
2. Medical billing company inks $500k false claims settlement.
Medical Reimbursement Systems, Inc., which provides billing, coding,
compliance and revenue cycle services to hospitals and physician practices,
agreed to pay the federal government $500,000 to resolve allegations it sub-
mitted false claims to TRICARE.
3. Rose Radiology settles false claims allegations for $8.7M.
Rose Radiology Centers in Tampa, Fla., agreed to pay the federal government
$8.71 million to resolve allegations it violated the False Claims Act.
4. Tenn. drug company settles false claims allegations for $7.8M.
Nashville (Tenn.) Pharmacy Services agreed to pay the federal government
$7.8 million to resolve allegations it submitted false claims to Medicare and
TennCare for medication for patients aer they had died.
5. Kindred Healthcare to pay $125M in false claims settlement.
Kindred Healthcare — the largest home therapy care provider in the
United States — agreed to pay the federal government $125 million to
settle allegations it knowingly allowed skilled nursing facilities to submit
false claims to Medicare. n
5 False Claims Act, Stark Law Settlements
By Ayla Ellison
11 Things for ASC Leaders to Know About ACOs
By Allison Sobczak
1. There were 782 privately-owned
ACOs covering 23 million lives as of
December 2015.
1
2. There are a few advantages for pro-
viders to join under an ACO model.
There's a lower cost of care, conve-
nient site of care and physician align-
ment. Moving some procedures from
the hospital outpatient department
setting to the ASC setting can contrib-
ute to ACO savings.
2
3. Though ACOs generate savings
by limiting avoidable billings, they
must still offer superior customer ser-
vice to effectively compete for patients.
ASCs are known as efficient, cost-effec-
tive facilities that can provide quality
care, therefore serving as a strong
competitive asset for ACOs.
4. An independent ASC in a very large
multi-hospital system community or
a small town dominated by one or
two hospitals may not fit into the ACO
structure, said to Kevin Arvin, Esq., vice
president ambulatory services for Sher-
idan Healthcare in a May 2013 Becker's
ASC Review Article titled "What do
ACOs Really Mean for ASCs?" Power-
ful hospital systems controlling the
ACO could cut ASCs out regardless of
potential savings. When independent
physician groups manage the ACO,
they're more likely to benefit from an
ASC's savings.
5. If surgeons in the community join a
hospital-driven ACO, they may no lon-
ger be able to bring cases to the ASC,
said to Mr. Arvin. One way to mini-
mize these situations is by strengthen-
ing the relationships between the ASC
and its hospital/physician partners.
6. Released in late 2011, federal en-
forcement agencies issued two waivers
that exempt ACOs from prosecution
under existing healthcare regulations
and affects ASCs both within and
outside of the ACO.
3
The first waiver,
involving antitrust laws, allows ACOs
to bring together normally compet-
ing providers — potentially ASCs — to
coordinate care. The second waiver,
involving healthcare fraud and abuse
laws, incentivizes physicians to use
new approaches to patient care, which
might include referrals to ASCs.
7. Federal enforcement lawyers spe-
cializing in the different areas of the
waivers said, under the first waiver,
surgery centers will be able to share
certain pricing information that is
normally kept confidential.
4
However,
even if ASCs do not join their local
ACO, the waiver affords them protec-
tions against the ACO's market power.
The second waiver allows the ACO to
use its "shared savings" payments to
reward providers to use more effective
forms of care.
8. Specialists can currently partici-
pate in more than one ACO; becom-
ing exclusive with one ACO limits the
potential for future growth.
5
9. If there are multiple ASCs within the
ACO, there are mixed incentives. For
example, leaders don't want the ACO
to pit ASCs against each other to push
payment down too low.
6
10. If the ACO's target patient popula-
tion is Medicare or another charity group,
it may not be beneficial for the surgery
center that currently has low Medicare
representation in the payer mix.
7
11. Its problematic if a leader's cen-
ter's electronic communication can't
communicate with other providers in
the ACO. The center may be forced to
purchase a new system or additional
technical capabilities to communicate
within the ACO, which is a considerable
expense for most centers, ranging from
$15,000 to $70,000 per provider de-
pending on whether the EHR-deploy-
ment is onsite or web-based.
8
______________________
1
American Hospital Association Re-
source Center Blog. "Projected Growth
of Accountable Care Organizations."
2
The Advisory Board Company. "ASCs
for ACOs: Is there an advantage?"
3
Physicians Endoscopy. "Will New
Legal Waivers for ACOs Affect Surgery
Centers."
4
Physicians Endoscopy. "Will New
Legal Waivers for ACOs Affect Surgery
Centers."
5
Becker's ASC Review. "How ASCs Are
Navigating the ACO Terrain & 8 Tips to
Mitigate Risk."
6
Becker's ASC Review. "How ASCs Are
Navigating the ACO Terrain & 8 Tips to
Mitigate Risk."
7
Becker's ASC Review. "How ASCs Are
Navigating the ACO Terrain & 8 Tips to
Mitigate Risk."
8
HealthIT.gov. "How much is this going
to cost me?"
