At the 11th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference on June 14, Jeffery Clark, partner at McGuireWoods, David Pivnick and James J. Schanaberger, associates at McGuireWoods, discussed emerging trends in ASC and healthcare litigation.
According to Mr. Pivnik, the number of litigation cases involving the False Claims Act has spiked in the last few years. The act allows the government to recoup the money it spent on paying fraudulent claims and also requires a person who knowingly submits a false claim to pay a penalty. The reason these cases have increased recently is because the government is taking an active role in healthcare fraud and is initiating investigations more frequently than before. To minimize risk, Mr. Pivnick advises healthcare organizations to take the following steps:
1. Organizations should have a compliance plan and ensure that everyone is adhering to it.
2. Organizations should conduct compliance training multiple times, annually if possible.
3. Organizations should encourage staff to report internally to mitigate litigation risk.
4. Once an organization has figured out the source of the problem, it should nip it in the bud immediately.
According to Mr. Schanaberger, cases centered on physician redemptions have also increased. These situations usually involve a healthcare organization redeeming the shares of a non-compliant physician, and Mr. Schanaberger suggests that healthcare organizations follow the original operating agreement closely. Follow every step so that physicians won't have any further causes to challenge the redemption, he said. Organizations could also consider buyout, that is, buying back the physicians' shares. While this would be less expensive and time-consuming than litigation, it could set a precedent. In the future, physicians could assume that they are entitled to a buyout if the organization chooses this route in a particular case, said Mr. Schanaberger.
According to Mr. Pivnik, the number of litigation cases involving the False Claims Act has spiked in the last few years. The act allows the government to recoup the money it spent on paying fraudulent claims and also requires a person who knowingly submits a false claim to pay a penalty. The reason these cases have increased recently is because the government is taking an active role in healthcare fraud and is initiating investigations more frequently than before. To minimize risk, Mr. Pivnick advises healthcare organizations to take the following steps:
1. Organizations should have a compliance plan and ensure that everyone is adhering to it.
2. Organizations should conduct compliance training multiple times, annually if possible.
3. Organizations should encourage staff to report internally to mitigate litigation risk.
4. Once an organization has figured out the source of the problem, it should nip it in the bud immediately.
According to Mr. Schanaberger, cases centered on physician redemptions have also increased. These situations usually involve a healthcare organization redeeming the shares of a non-compliant physician, and Mr. Schanaberger suggests that healthcare organizations follow the original operating agreement closely. Follow every step so that physicians won't have any further causes to challenge the redemption, he said. Organizations could also consider buyout, that is, buying back the physicians' shares. While this would be less expensive and time-consuming than litigation, it could set a precedent. In the future, physicians could assume that they are entitled to a buyout if the organization chooses this route in a particular case, said Mr. Schanaberger.