HHS OIG Releases Advisory Opinion Finding A Company Model Type Arrangement May Violate the Federal Anti-Kickback Statute
ASA applauds the U.S. Department of Health and Human Services Office of the Inspector General's (HHS-OIG) release of Advisory Opinion No. 13-15, which addresses a specific company model-like arrangement in a hospital setting involving anesthesia services and a psychiatry group. The opinion found that the referenced company model-like arrangement, which would allow the referring physician to retain anesthesia revenue, could violate the Federal Anti-Kickback Statute.
Specifically, HHS-OIG found that the proposed arrangement appeared to be designed to permit the referring physician psychiatry group "to do indirectly what it cannot do directly; that is, to receive compensation, in the form of a portion of Requestor's anesthesia services revenues, in return for the Psychiatry Group's referrals of ECT patients to Requestor for anesthesia services." The opinion concluded that the proposed arrangement "could potentially generate prohibited remuneration under the Anti-Kickback Statute and that the OIG could potentially impose administrative sanctions" with the caution that "any definitive conclusion regarding the existence of an anti-kickback violation requires a determination of the parties' intent, which…is beyond the scope of the advisory opinion process."
ASA has repeatedly called for investigations into company model arrangements and ASA members participated in a grassroots call to action voicing opposition to the company model. The ASA Committee on Practice Management (CoPM) is currently conducting a three-month pilot to solicit information on company model and similar types of arrangements.
Review the Advisory Opinion No. 13-15.
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Learn more about CoPM's company model pilot member solicitation.