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Legal Issues in Anesthesia
2014Jan Mannino, CRNA, JD
Laguna Niguel, CA
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Contracts
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Introduction Terms of relationship defined Legal remedy if breached Perception of business approach to practice
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Types of Contracts Written Verbal
Not appropriate for some transactions, such as real estate More difficult to prove
Implied by actions
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Parts of a Contract
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Identification of parties CRNA or Business Entity Hospital, Surgeon, etc.
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Dates Starting Ending Term
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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
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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
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Exclusive Contract May be important if you are relocating Could have some anti-trust components Make sure you can fulfill obligations
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Non-Compete Clause Geographic component Time Component Viewpoint of CRNA Viewpoint of Hospital/Group
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Compensation Part of every contract May be addendum to contract Clear and not open to interpretation
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Contract for Anesthesia Services What hospital/facility will provide Time obligation Clinical Services Administrative Services Assignment of cases
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Contract for Employment Salary Benefits Time commitment Services to be performed
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Antitrust and Anesthesia
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Joint Conduct Section 1 of the Sherman Act Contracts, combination or conspiracy in restraint of trade is
unlawful Elements
Agreement Harm to competition
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Define a relevant market Substitutability Product or service Geography
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Agreements among competitors Price fixing Division of customers Market allocation
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Unilateral Conduct Attempts to monopolize Actual monopolization
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Anticompetitive Conduct Predatory pricing Raising barriers to competitors (Michigan BCBS)
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Specific antitrust issues in healthcare Staffing and privileges Exclusive contracts Joint negotitaitons with payors Information sharing Packaged pricing
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Exclusive Contracts Market forces prevail
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Many Anesthesia Antitrust Cases
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Billing Issues OIG Advisory Opinion 12-6
See text of opinion in handouts
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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
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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
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Sutter Health Anesthesia Fraud Hospital anesthesia charges
$1610 for first half hour $457.50 for each subsequent 15 minutes
Not the professional fee
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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
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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
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Thank you UNF Other faculty members Audience