Medicine & the Law

The promotional activities of drug and device companies--and the responses of health care professionals to these promotions--are under close scrutiny from enforcement agencies. Physicians and hospitals should acquaint themselves with the various initiatives under way and review their own practices against the ever-stricter standards.

A proposed consent decree filed by the Department of Justice has further validated the use of the third-party messenger model as a means of collectively dealing with managed care contracting while avoiding antitrust scrutiny. The messenger model will come under scrutiny when it is used principally to strengthen the bargaining power of physician group participants, but it may be used appropriately to facilitate information exchange between plans and physicians, thereby enhancing the negotiation process by independent groups.

A physician subjected to peer review may have little chance of surviving unless early and aggressive measures are taken, facilitated by an understanding the case law and limitations on judicial remedies

Physicians who make the best expert witnesses are those who do so occasionally, have unique expertise and get involved because they realize the true importance of the task. Here are guidelines on what to expect.

A recent court decision should serve as a wake-up call for physician practices to analyze their compensation policies. This decision raises the specter that the IRS may now begin reviewing distributions by physician corporations more closely.

By working together, physicians can add valuable expertise to their practices, share their administrative burdens and limit the necessity of outside patient referrals, lowering their costs and expanding their revenue. Like most new endeavors, however, the decision of whether and how MDs, DOs and DCs should enter into multidisciplinary practices is ripe with legal aspects that must be carefully considered.

Hospital Outpatient Prospective Payment System (HOPPS) implementation may have important ramifications for imaging services heretofore delivered primarily in hospitals. More radiology procedures may well be shifted out of the hospital setting and some hospitals may see the advantages of working with radiology groups on outpatient diagnostic imaging center joint ventures.

Under the new procedure, reconsideration of claims will be heard by independent external contractors no longer bound by local carriers’ medical review policies.

A professional's candid but carefully worded explanation of an embarrassing situation will serve him or her far better than any attempt to hide the information. At the first hint of a problem, the professional is wise to proactively seek a creative way to resolve the situation.

Gainsharing's surprise recovery came in the form of an Advisory Opinion issued by the OIG. Although the OIG reiterated its concerns regarding the potential adverse affects of gainsharing on patient care and its potential for disguising payments for referrals, it permitted the hospital and physicians to enter into the carefully structured cost-sharing arrangement proposed by the requestors.