Physicians working in an outpatient setting, whether that’s an office-based lab (OBL) or ambulatory surgery center (ASC), face increasing scrutiny over whether the procedures they perform are done with the patients’ best interests in mind. One lawyer described the legal landscape, with advice on how to avoid getting embroiled in trouble, TCT MD reports.
“What’s driving the enforcement and investigations in the outpatient setting? The answer is: it’s complicated,” said Jason Greis, JD (Benesch Law, Chicago, IL).
Setting up and running the facilities is complex, as are the legal and regulatory frameworks on a state and federal level, he pointed out.
“As the OBL industry has grown, so too has enforcement in the industry. Regulators and investigators have followed both the flow of money and are also responding to complaints from patients, physicians, and payers alike,” Greis continued. “Whether it’s botched Brazilian butt lifts here in Florida or procedures that may not be supported by medical necessity, such as overuse of atherectomy and angioplasty, questionable referral practices intended to increase patient volumes in the OBLs, or overly complex procedures arguably being performed [on an outpatient basis]: as a result of that, states and the federal government are coming up with new laws and enforcement actions to keep everyone in check.”
Florida, New York, New Jersey, California, and Pennsylvania stand out as states acting more proactively in this area, Greis said. But oftentimes enforcement begins with whistleblowers “who at the end of the day, if they bring a case to the government, stand to gain 25-35% of the recovery,” he added, “so there’s a lot of money to be made.” The private equity that’s funding many of these facilities, and the potential for profit, also captures investigators’ attention. Read more.
