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FSA Qui Tam Suit Against “Company Model” Providers
In October 2013, the Florida Society of Anesthesiologists filed a qui tam action under seal as required, which named as defendants a large number of Florida GI physicians, surgery centers, and “company model” anesthesia providers. The action was unsealed and made public during the last week of March.
Chief among the FSA’s allegations is that the defendants violated the federal False Claims Act by billing and collecting for anesthesia services performed by captive “company model” anesthesia providers.
At its simplest, the term “company model” refers to an anesthesia company jointly owned by referring physicians and anesthesiologists that is formed to provide anesthesia services at the ambulatory surgery center that the referring physicians own. The jointly owned anesthesia company takes the place of anesthesiologists (or an entity owned 100% by them) which previously performed the anesthesia services for the ASC. By using the company model arrangement, the referring physicians are then able to share in the revenues generated by the anesthesia services that previously would go solely to the anesthesiologists who performed the services.
The OIG made it clear in its Advisory Opinion 12-06 posted on June 1, 2012 that the company model and similar arrangements “could potentially generate prohibited remuneration under the anti-kickback statute and that the OIG could potentially impose administrative sanctions.” The American and Florida Societies of Anesthesiologists had been urging the OIG to take action like this for a long time, and it is not surprising that the FSA would take the lead in filing a qui tam action on company model arrangements that continued after the OIG posted its opinion.
This is a very significant case. The U.S. Attorney’s Office has presently declined to intervene, but its investigation is ongoing.
The Doctors Company – Ransomware Attacks
The Doctors Company, a physician-owned malpractice insurer, recently posted an article on so-called “ransomware” attacks on healthcare providers. Ransomware is a software virus that infects your computer network by encrypting all of your data so that it cannot be accessed without typing in the encryption key which the ransomware attacker will provide for a price.
I have a lawyer colleague whose law firm was the victim of a ransomware attack. Fortunately, the firm did frequent backups and all the data could be restored without having to pay the ransom. However, there was great disruption to the office, work essentially stopped, and everything has not quite been the same since the data was restored.
The Doctors Company’s article says that ransomware victims only have three options – restore the data (but that requires frequent backups), pay the ransom, or lose the data. For most organizations, especially those in healthcare, choosing to lose the data is not a viable option.
Victims face the loss of business, inconvenience to patients/clients/customers, damage to reputation, and potential liability if needed data is not available and a patient or client or customer is adversely affected.
Prevention, vigilance, and employee education are all critical to responding effectively to a ransomware attack.
Health Rankings — Pinellas County and Hillsborough County
The following infographic from the Suncoast Health Council compares various health factors between Pinellas and Hillsborough Counties, Florida:
Health News Florida
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Physicians Practice
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Joseph Rugg's Health Law Blog 