tci Medicare Compliance & Reimbursement - 2007 Issue 25
COMPLIANCE: Hospital Ownership--If Doctors Want Out, They Can't Profit From Their Clout
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Article Overview
This compliance article examines an HHS Office of Inspector General view of a proposed ownership change involving an ambulatory surgery center and a local hospital. It is aimed at compliance professionals, physicians, and healthcare administrators who need to understand the general fraud-and-abuse concerns that can arise when provider ownership, investment, and referral relationships overlap. The discussion focuses on the broad compliance issues raised by hospital-physician joint ventures and how proposed buyout arrangements can attract scrutiny.
Why This Topic Matters
Ownership and investment arrangements between physicians and hospitals can raise compliance concerns if they appear to connect investment returns with patient referrals. Understanding the general risk area helps organizations evaluate proposed transactions before they create regulatory problems.
What You Will Learn
- How physician ownership changes in an ambulatory surgery center can attract compliance scrutiny
- Why hospital-physician joint ventures may raise fraud-and-abuse concerns
- What broad issues regulators may consider when evaluating a proposed buyout arrangement
- How ownership structure and referral relationships can intersect in compliance analysis
Who Should Read This
- Compliance officers
- Physicians
- Hospital administrators
- Healthcare attorneys
- Practice managers
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