Provided by:  Jennifer Kirschenbaum, Esq.

June 6, 2019





Is it illegal to make money in healthcare today?

What do you think?

Dr. C 

With the investigations going on today, I completely understand the question.  It's gangbusters out there, and the flavors of the week are people of influence and money.  Our medical community is still a top tier profession (despite best efforts by some to destroy the payment system).  So, what is the deal with FMV at hospitals  and concern over the take home number?  Why is making money indicative of doing something wrong?  Why can't a doctor just be great at what she or he does, and be rewarded for it?   Such tough questions.  The obvious answer is, well, don't we live in a free market and "be my guest"?   Not when the free market is paying you with tax payor dollars; law makers prefer to funnel that money elsewhere - perhaps to a Recovery Audit Contractor?   

The kickback article is interesting.  The concept taken by the author that hospitals are paying more to recruit specialists just to drive referrals is a cynical tale prosecutors weave for anti-kickback convictions.  The reality is, if you court a specialist - an orthopedic surgeon - in a remote hospital previously without that service, aren't you now going to be seeing a substantial uptick in facility fees due to the ability to perform new procedures?  Isn't that good for that community? Shouldn't that individual be paid for their efforts? Or should we continue down the rationing road where we only win as a society if we pay out less claims, fewer services, more money to healthcare administration and less to the providers?   If the same money is coming in to the facility and less is going to the provider because the number is "outside the curve", then the monies the hospital would have paid to get the provider to the remote facility is now up for grabs to someone else.  Perhaps someone in administration making decisions on which pharma to use?  Lose/Lose.  

For practicality sake, let's address high earners/high utilizers.  Are they targets?  You bet.   Being a high utilizer/high producer does risk putting you on the radar.  So, how do you best protect yourself from a target on you - take the time to train on and adopt proper documentation guidelines.  Stick to Incident To/Supervision Requirements if you are supervising.  Follow the coding rules.  Follow referral rules, on the way in and on the way out for a patient.  If you are offered compensation that seems too good to be true, review with an attorney, because it may be too good and a potential red flag for you and your practice.  Concerned over a practice area, run it by me preventatively.