By: Dave Davidson
The last few weeks have seen some significant examples of the federal government’s vigilance in policing the healthcare market. These events serve as a reminder of the highly regulated and scrutinized industry in which we work. They are also a reminder to physicians and other providers to make sure their practices and contractual arrangements can pass this scrutiny.
The most significant recent event is the $115 million settlement between the government and the Adventist Health System. This settlement resolved two whistleblower cases brought against the system by three employees. The lawsuits alleged that the Adventist Health System violated the Stark law, which generally prohibits payments to physicians for making referrals unless an exception to the law is met. The specific allegations against the Adventist Health System were that the compensation paid by the health system to some of its employed physicians exceeded fair market value; that the structure of the practice of the employed physicians did not meet the “group practice” exception; that physician compensation improperly included payment work not performed by the physicians; and that the physicians were paid for making referrals to the system. Continue reading