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Medicine & the Law

Fraud enforcement of Rx marketing practices

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.

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Justice Dept. OKs third party messenger model

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.

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Structuring physician-chiropractor relationships

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.

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Opportunities for joint ventured imaging services

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.

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Disciplinary actions against physicians

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.

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OIG approves hospital-physician gainsharing

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.

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