2. Self Referrals 2 Flashcards
What is the significance of Section 139.3 in relation to physician referrals?
Section 139.3 prohibits certain physician referrals but does not apply to a physician who refers a patient for a good or service if there is no alternative provider of the service within either 25 miles of the physician’s regular practice.
What implications does subdivision a of Section 139.3 have on physician practices?
Subdivision a of Section 139.3 prohibits certain referrals but has exceptions for physicians who can demonstrate the absence of alternative providers within a specified distance.
What is the required action for a physician when referring a patient to an organization in which they have a financial interest?
The physician must disclose this financial interest to the patient or the patient’s parents or legal guardian in writing at the time of referral.
What are the consequences for a physician if they do not disclose their financial interest during a referral?
Failure to disclose the financial interest may lead to legal implications loss of patient trust and potential disciplinary action by medical boards or organizations.
Under what conditions is a physician allowed to refer a patient to another physician person or entity with whom they have a financial arrangement?
A physician is allowed to refer a patient if they have arrangements such as a loan with commercially reasonable terms a lease for space or equipment or if these arrangements do not influence the referral or the volume of services provided by either party.
What are the key conditions that must be met for a loan between a physician and a referral recipient to be permissible?
The loan must have commercially reasonable terms bear interest at the prime rate or a higher rate that does not constitute usury be adequately secured and the loan terms must not be affected by either party’s referrals or the volume of services provided.
Define ‘usury’ in the context of loans between physicians and referral recipients.
Usury is the practice of charging excessively high-interest rates on loans which is often illegal and contrary to commercially reasonable terms.
What is meant by ‘commercially reasonable terms’ in the context of loans between physicians?
Commercially reasonable terms refer to loan conditions that are fair and standard within the industry ensuring that the borrower can repay the loan without undue hardship.
When is a lease between a physician and a recipient of a referral considered permissible?
A lease is considered permissible if the terms are fair commercially reasonable and not influenced by the physician’s referrals or the volume of services provided.
What is the significance of written disclosures in physician referrals?
Written disclosures ensure transparency and protect patients’ rights by informing them of any potential conflicts of interest that may affect their healthcare decisions.
What should a physician do immediately after making a referral where a financial interest is involved?
The physician should promptly provide the required written disclosure to the patient or the patient’s parents or legal guardian regarding the financial interest.
What types of arrangements are specified as potentially acceptable for physician referrals?
Acceptable arrangements include loans and leases provided they meet specified legal and ethical criteria and do not influence the referral process.
What are the characteristics of a compliant lease agreement in a healthcare context?
A compliant lease agreement must be written have commercially reasonable terms include a fixed periodic rent payment have a term of one year or more and ensure that lease payments are not influenced by either party’s referrals or the volume of services provided.
What constitutes a compliant ownership of corporate investment securities for physicians?
For a physician’s ownership of corporate investment securities to be compliant the shares bonds or debt instruments must be purchased on terms available to the general public through a licensed securities exchange or NASDAQ. The profit distributions or transfers of value must not be based on the physician’s referrals to the corporation and should not have a separate class or accounting for persons or physicians referring individuals to the corporation. Additionally the corporation must have total gross assets exceeding $100000000 at the end of its most recent fiscal year.
What criteria must a personal services arrangement meet for compliance from a physician or an immediate family member’s perspective?
A personal services arrangement must adhere to relevant regulations ensuring there is a genuine need for the services that the compensation is fair market value and that the arrangement is not tied to referrals for services that the physician could provide.
List factors that would make a lease agreement in healthcare potentially non-compliant.
A lease agreement could be non-compliant if it is not in writing lacks commercially reasonable terms has variable lease payments based on referrals has a term of less than one year or has other arrangements that could compromise the integrity of physician referrals.
Define ‘commercially reasonable terms’ in the context of healthcare leases.
Commercially reasonable terms refer to terms that are consistent with those that would be agreed upon by unrelated parties in a comparable situation without regard to volume or value of referrals.
What is the significance of having total gross assets exceeding $100 million in corporate investment securities ownership?
Having total gross assets exceeding $100 million indicates a certain level of financial stability and size that aligns with regulations suggesting that the investment securities are not merely a vehicle for illegal profit-sharing arrangements with referring physicians.
Why is it important for lease payments not to be affected by referrals in healthcare?
It is crucial for lease payments to be unaffected by referrals to avoid any potential conflicts of interest kickback arrangements or violation of anti-referral laws that could compromise patient care and transparency in healthcare services.
What roles do NASDAQ and licensed securities exchanges play in compliant corporate investment ownership by physicians?
NASDAQ and licensed securities exchanges provide regulated platforms for purchasing securities ensuring that the terms are fair and publicly available which helps to maintain compliance with regulations regarding investments made by physicians.
What are the requirements for the written arrangement of a referral?
- It must be set out in writing and signed by the parties involved. 2. It must specify all the services to be provided by the physician or an immediate family member. 3. The aggregate services contracted must not exceed what is reasonable and necessary for legitimate business purposes. 4. A written notice disclosing the existence of the personal services arrangement must be provided to specific persons at the time the services are first provided.
Who must receive the written notice disclosing the personal services arrangement?
The written notice must be provided to: 1. An injured worker referred by the licensee or their immediate family member. 2. The injured worker’s employer if self-insured. 3. The injured worker’s employer’s insurer if insured.
What must the written notice include regarding the personal services arrangement?
The written notice must include information on where a person can file a complaint against the licensee or the immediate family member of the licensee.
What does the term ‘immediate family member’ refer to in this context?
An immediate family member typically refers to the spouse children siblings or parents of the physician. The definition may vary based on jurisdiction but generally encompasses close relatives.
