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Appeals Court Expounds on Physician Self-Referral Violations
April 27, 2012
G2 Intelligence Reports
Rob Mazer is quoted by G2 Intelligence Reports in this look at United States ex rel. Drakeford v. Tuomey Healthcare System Inc. In this case, the US Court of Appeals for the Fourth Circuit overruled a lower court ruling that required Tuomey Hospital to repay the government $44.9 million, in part for violating the Stark law banning physician self-referrals.
In comments to NIR, attorney Robert E. Mazer, a principal at Ober|Kaler (Baltimore), said the majority decision is significant because of the particular government interpretations of the Stark law and regulations that it upheld and because it indicates that courts will likely give significant weight to agency interpretations presented in the preamble to the Stark regulations.
“Generally, when independent physicians (that is, physicians who do not work for a hospital or a related entity) perform procedures in a hospital facility, the physician or his medical group bills the patient or payer for his or her professional services. The hospital bills for use of its facility (the facility fee), including related supplies equipment, and nonphysician personnel,” Mazer noted.
“In this case, a contract between the parties required the physicians to perform certain outpatient surgical procedures at the hospital and for the hospital to bill for both the physician’s professional service and the facility fee. The hospital would pay the physician for his or her professional services. The payment formula is somewhat unclear, but it appears that the physician’s compensation reflected a fixed salary and amounts collected for his or her professional services. It also appears that the physician may have received more than payment received by the hospital for his or her professional services.”