decisionhealth Newsletters, Coder Pink Sheets - 2018 Issue 5 (May)
Compliance: Site-of-service inducements land ortho, anesthesia practices in a bad place
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Article Overview
This article examines a federal whistleblower settlement involving an orthopedic practice, an ambulatory surgery center, and an anesthesia group. It focuses on alleged site-of-service inducements, related compliance concerns, and a separate false claims allegation tied to non-U.S. prescription drugs. The piece is relevant to compliance officers, practice administrators, orthopedic and anesthesia providers, and revenue cycle professionals who monitor fraud-and-abuse risk.
Why This Topic Matters
It highlights how referral relationships, facility arrangements, and payment incentives can create federal fraud-and-abuse exposure for physician practices and surgery centers. It also shows why compliance programs need to watch for whistleblower risk, employment actions tied to internal reporting, and billing issues that can trigger government scrutiny.
What You Will Learn
- How whistleblower allegations can involve multiple healthcare entities in one settlement
- Why referrals and facility-related arrangements can raise compliance concerns
- How separate false claims allegations may be included in the same government resolution
- What types of organizations and provider relationships are commonly implicated in fraud-and-abuse cases
Who Should Read This
- Compliance officers
- Medical practice administrators
- Orthopedic practices
- Anesthesia practices
- Ambulatory surgery centers
- Healthcare attorneys
- Revenue cycle staff
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