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Legal Issues in Anesthesia 2014

Legal Issues in Anesthesia 2014. Jan Mannino, CRNA, JD Laguna Niguel, CA. Contracts . Introduction. Terms of relationship defined Legal remedy if breached Perception of business approach to practice. Types of Contracts. Written Verbal

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Legal Issues in Anesthesia 2014

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  1. Legal Issues in Anesthesia2014 Jan Mannino, CRNA, JD Laguna Niguel, CA

  2. Contracts

  3. Introduction • Terms of relationship defined • Legal remedy if breached • Perception of business approach to practice

  4. Types of Contracts • Written • Verbal • Not appropriate for some transactions, such as real estate • More difficult to prove • Implied by actions

  5. Parts of a Contract

  6. Identification of parties • CRNA or Business Entity • Hospital, Surgeon, etc.

  7. Dates • Starting • Ending • Term

  8. Termination Clause • Notice of termination without cause • Usually 3 months • Effectively a 3 month contract • With cause • Specific relating to loss of licensure or serious issue

  9. Due Process • Not usually given to CRNAs through medical staff policies • Have clause in contract that gives you due process rights in clinical issues • Protection of practice

  10. Exclusive Contract • May be important if you are relocating • Could have some anti-trust components • Make sure you can fulfill obligations

  11. Non-Compete Clause • Geographic component • Time Component • Viewpoint of CRNA • Viewpoint of Hospital/Group

  12. Compensation • Part of every contract • May be addendum to contract • Clear and not open to interpretation

  13. Contract for Anesthesia Services • What hospital/facility will provide • Time obligation • Clinical Services • Administrative Services • Assignment of cases

  14. Contract for Employment • Salary • Benefits • Time commitment • Services to be performed

  15. Antitrust and Anesthesia

  16. Joint Conduct • Section 1 of the Sherman Act • Contracts, combination or conspiracy in restraint of trade is unlawful • Elements • Agreement • Harm to competition

  17. Define a relevant market • Substitutability • Product or service • Geography

  18. Agreements among competitors • Price fixing • Division of customers • Market allocation

  19. Unilateral Conduct • Attempts to monopolize • Actual monopolization

  20. Anticompetitive Conduct • Predatory pricing • Raising barriers to competitors (Michigan BCBS)

  21. Specific antitrust issues in healthcare • Staffing and privileges • Exclusive contracts • Joint negotitaitons with payors • Information sharing • Packaged pricing

  22. Exclusive Contracts • Market forces prevail

  23. Many Anesthesia Antitrust Cases

  24. Billing Issues • OIG Advisory Opinion 12-6 See text of opinion in handouts

  25. False Claims Act • Encourages whistleblowers to report fraud • UCI situation • Anesthesia records signed before the cases • Improper supervision ratios of residents and CRNAs • Settlement for $1.200,000 • Whistleblower received $120,000

  26. Sutter Health Anesthesia Fraud • Double billing by hospital for anesthesia services • Anesthesia fees posted on website • Civil suit filed by Rockville Recovery Associates • Anesthesia billing audit firm • Settled for $46,000,000 • California Department of Insurance

  27. Sutter Health Anesthesia Fraud • Hospital anesthesia charges • $1610 for first half hour • $457.50 for each subsequent 15 minutes • Not the professional fee

  28. Vanderbilt University • Surgery schedules showed surgeons were booking simultaneous cases in different parts of the hospital • Anesthesia billing issues with supervision • Recent openings at Vanderbilt

  29. Future Concerns • Corporate practice of anesthesia • More fraud investigations • Data driven practice • Middle management more control • More businesses making money off of anesthesia services • More levels between the anesthesia professional and the patient

  30. Thank you • UNF • Other faculty members • Audience

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