decisionhealth Newsletters, Part B News - 2013 Issue 7 (July)
OIG nixes lab service arrangement — but lets podiatrist sell to footsore employees
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Article Overview
This article explains two recent Office of Inspector General advisory opinions involving physician-related ancillary business arrangements. It is relevant to healthcare compliance, physician-owned business planning, and billing professionals who monitor anti-kickback statute risk, safe harbor concepts, and the structure of lab and podiatry-related service models. The discussion focuses on why one arrangement was viewed as problematic and why another was conditionally approved, along with broader compliance themes for Medicare providers.
Why This Topic Matters
Healthcare organizations and physician entrepreneurs need to understand how OIG views business arrangements that may affect referrals, federal program business, and compliance risk. The article helps readers recognize the kinds of structure and intent issues that can trigger scrutiny when developing ancillary services.
Article Sections
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Compliance
Introduces the topic and frames the article around two OIG advisory opinions involving ancillary business arrangements and compliance concerns.
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The trouble with carve outs
Discusses concerns about separating federal and non-federal business in a laboratory-related structure and why such arrangements draw scrutiny.
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Ways to fix it
Summarizes possible structural changes that might reduce regulatory concerns in a laboratory-management context.
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One arrangement that works
Reviews a podiatry-related business arrangement that received conditional approval and the general compliance factors considered.
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Dot every ‘i’
Concludes with broader compliance takeaways for physicians considering ancillary businesses and the need to anticipate OIG review.
What You Will Learn
- How OIG advisory opinions can affect physician-owned ancillary business planning
- Why laboratory-related management structures may raise anti-kickback concerns
- What broad compliance factors can make a podiatry-related business arrangement more defensible
- How Medicare providers are advised to think about regulatory scrutiny when developing new services
Who Should Read This
- Healthcare compliance professionals
- Physicians and medical practice owners
- Practice administrators
- Medical billing and reimbursement staff
- Healthcare attorneys
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