[ Thursday, September 13, 2007 ]


Off Topic: The Illinois Imaging Center Leasing Cases. I represent a lot of radiologists, and this is a big item in the radiology field right now. Here's the set-up: due to concerns about over-utilization and ensuring that physicians choose where to refer their patients based on the best and most appropriate care for the physician, it is generally illegal for a physician to seek or receive a payment or kickback in exchange for referring a patient to another provider, if the patient is a government-pay patient (in some states, the same restriction applies regardless of who's paying for the patient's care). A physician sees a patient and determines that the patient needs a CT scan or an MRI. The physician can send the patient any number of independent imaging centers to have that done, but the imaging centers can't give the physician a financial incentive to use them. Conversely, the physician could own (or lease) his own CT scanner in his own office and send the patients there as an ancillary service, and that would be OK too. It would be illegal for one of the imaging centers to tell the physician, if you send a patient here, we'll give you 10% of what we get when we bill for that patient. What if one of the imaging centers told the physician, we will rent you our imaging center for that one scan, and charge you 90% of our normal charge, and you can then bill the patient's payor 100%? That would effectively be the same thing as the 10% kickback, but it would look a little more like the physician having his own CT scanner.

Well, not surprisingly, there are a lot of physicians and imaging centers who have arrangements that look like that. The problem is determining if the arrangement is more like the kickback or more like the ancillary service. The Illinois Attorney General has come after a couple dozen imaging centers, accusing them of setting up similar deals as a blatant attempt to pay a kickback while disguising it as an equipment lease. The case is naturally drawing lots of attention, and there's a recent development: the AG will have to refile the case with specific allegations about each of the imaging centers and how they have set up their arrangements. It's not a big setback for the AG, but she'll have to put in a little more work on the front end.

Jeff [11:03 AM]

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