How to Avoid Fraud Owning A Medical Service

Do you have a financial interest in an ancillary healthcare service?  You could be accused of fraud.  Many doctors owned imaging services, diagnostic labs, pharmacies, physical therapy companies.  A new study suggests that you will order more of that service if you will benefit financially.

“A new study has found that patients are more likely to have magnetic resonance imaging scans that indicate nothing is wrong if they are referred by a doctor who owns the machine. The scientists conclude that doctors with a financial interest in the machines may be more likely to order M.R.I.s even when clinical findings suggest they are unnecessary.

The researchers reviewed referrals for knee M.R.I. examinations made by two physician groups, one with a financial interest in a scanner, the other without. There were 350 referrals in each group, and none of the patients had had a previous M.R.I. or knee surgery. The study was published online in Radiology.

Of the 700 examinations, 205 had negative results, indicating no abnormalities. But the rate of negatives was 33 percent in patients referred by doctors who owned the machine, compared with 25 percent of patients referred by those without a financial stake in the device.”

New York Times, September 23, 2013

With the addition of the Sunshine Act and various other complex regulations, patients are getting more information about how a doctor benefits financially from the healthcare services ordered.  Every practice should be transparent about their ownership to the public.  Otherwise, you could be committed fraud.

The number one rule is that you can never accept a “finders fee” for referring a patient to an ancillary service.  Every doctor is expected to be free of “conflicts” and order the best care for the patient.  By taking any “fee” including free tickets or free golf, it will be perceived as fraud and a violation of the anti-kickback for the referral.

Some of the regulations require not only notice to the patient of the ownership but also providing a list of other alternative locations for the service.  You must clearly comply with the Stark and Anti-Kickback Rules.  Violation of these rules could result in massive fines and penalties.

Tell us how you inform patients of your ownership in an ancillary service?   Share your ideas with us by clicking on the comment button below.  We’d love to hear from you.

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