July 6, 2022

Justice Department showing closer inspection of ASC, anesthesia provider arrangements

By: Tarsilla Moura

Editor's Note

According to a June 20 article published by JDSupra from law firm Waller Lansden Dortch & Davis, recent government action out of the Justice Department involving ambulatory surgery centers (ASCs) and anesthesia provider arrangements points "to a need to carefully vet these partnerships,” Becker’s ASC Review June 21 reports.

In April, anesthesia management services company Care Plus Management; its founders Paul Weir and John Morgan; and 18 anesthesia entities Care Plus owned agreed to pay $7.2 million to settle allegations of kickbacks and false claims. The case encompassed allegations that Weir and Morgan had convinced ASC physician owners to award them exclusive service agreements in exchange for partial ownership in Care Plus anesthesia entities between 2012 and 2016.

This case is similar to a settlement from November 2021, when three anesthesia providers and several ASCs in Georgia, along with their physician owners and an administrator, agreed to pay more than $28 million to resolve allegations that they had entered kickback agreements, Becker’s noted.

Here are some recommendations ASC administrators should keep in mind when structuring anesthesia contracts, according to the authors:

  • Monitor overlapping ownership between a service provider and the referral source.
  • Arrange for coverage by the anesthesia provider and require each party to bill patients and payers separately.
  • Be wary of scenarios in which the provider performing and billing for services is outsourcing the financial risk.
  • Note that contracting facilities are also at risk, so ASCs should monitor how the contracting provider is structured.

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