By: Christopher A. Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, Ma.

Ascension Macomb Oakland Hospital in Michigan recently settled a case with the HHS Office of Inspector General (OIG) involving allegations of improper remuneration. The hospital agreed to pay $100,000 as part of the settlement, which arose from self-disclosure to the OIG. The case centered around the provision of free services to certain physicians by advanced practice providers (APPs) between July 16, 2014, and Dec. 1, 2020. Specifically, the hospital was alleged to have provided clinical staff, namely APPs, to perform pre-surgical histories and physicals for physicians at no cost, which OIG viewed as remuneration to physicians who referred patients to the hospital for surgeries.

This settlement is notable for its implications under the Anti-Kickback Statute (AKS) and the Stark Law, highlighting the complexities surrounding the use of APPs in clinical care. The AKS and Stark Law are critical regulations in the healthcare sector, aimed at preventing undue influence on patient care decisions and maintaining the integrity of medical judgment.

The role of APPs in a hospital setting, especially when it comes to collaboration with physicians, is a nuanced issue. As pointed out by attorney Holley Thames Lutz of Dentons US LLP, hospitals employing APPs for bona fide, patient-centric reasons, such as improving patient outcomes and satisfaction scores, should not necessarily fear fraud and abuse laws. The importance lies in ensuring that APPs’ services are complementary to, rather than replacements for, those of physicians.

In terms of Medicare regulations, APPs are authorized under the Medicare Conditions of Participation to write the history and physical (H&P). The Medicare Claims Processing Manual’s Global Surgical Package (GSP) includes various components such as preoperative and postoperative visits, and management of complications, which are relevant in this context. The manual also notes that services related to surgery provided by physicians outside the surgeon’s group practice during the GSP period can be billed separately by Medicare.

This case underlines the importance for hospitals and healthcare providers to navigate the complex regulatory landscape carefully, especially when it involves collaborations between different types of healthcare providers. The nuances in these regulations and their interpretations play a significant role in determining compliance and legal liabilities. If you have an questions or concerns regarding the facts surrounding this OIG settlement, please don’t hesitate to call our firm at 857-328-0382 or email us at info@parrellahealthlaw.com