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Anti-kickback rules place physicians in unsettled waters.
1Smith Shaw and McClay, Washington, D.C.
Pennsylvania Medicine
|September 1, 1991
Summary
Medicare is enacting significant payment reforms, including the Resource-based Relative Value Scale (RBRVS). New federal rules and a fraud alert address physician-supplier business relationships under Medicare's anti-kickback statute.
Area of Science:
- Healthcare policy
- Medical economics
- Regulatory compliance
Background:
- Medicare payment systems are undergoing substantial reforms.
- Physician reimbursement is being restructured via the Resource-based Relative Value Scale (RBRVS).
- Increased scrutiny of business arrangements between healthcare providers and suppliers is evident.
Purpose of the Study:
- To inform healthcare providers and suppliers about new Medicare regulations.
- To clarify the interpretation of Medicare's anti-kickback statute.
- To highlight the focus on business relationships in recent federal guidance.
Main Methods:
- Analysis of new federal rules and guidance.
- Interpretation of Medicare's anti-kickback statute.
- Review of "Fraud Alert" issued by the government.
Main Results:
- The Resource-based Relative Value Scale (RBRVS) represents a major change in physician payment.
- New regulations and a "Fraud Alert" have been issued by the federal government.
- The anti-kickback statute's interpretation now emphasizes provider-supplier business relationships.
Conclusions:
- Physicians and suppliers must be aware of evolving Medicare regulations.
- Compliance with the anti-kickback statute is critical, particularly concerning business relationships.
- These changes signal a stricter enforcement environment for Medicare transactions.