LP6.2 Assignment: Reverse Referral Fees The assignment will assess the competenc
ID: 367523 • Letter: L
Question
LP6.2 Assignment: Reverse Referral Fees The assignment will assess the competency 9. Analyze basic legal principles of antitrust law and referral fees law. Directions: Complete the Problem on page 579 “Reverse Referral Fees” as a two to three page paper. For a general description of Marcus Welby Hospital see page 369 of the text. You are outside counsel to the Marcus Welby Healthcare Corporation (MWHC), which is concerned that expenses in some of its ancillary departments are causing it to lose money under Medicare and HMO insurance. It would like to start charging its hospital-based physicians for some of the costs of running their departments. Its current relationship with these physicians is one in which they have exclusive contracts to work in these departments, but no money changes hands between them. The hospital handles all billing, staffing, and overhead, but it bills separately for facility charges versus professional fees, and the physicians keep all the professional fees the hospital collects on their behalf. This is the standard practice in the industry. MWHC has the following suggestions for changing this arrangement: • Have the radiology group pay for services, supplies, personnel, utilities, maintenance, and billing services furnished by the hospital. In a non-hospital, office-based setting, this package would normally cost about $100,000 to $150,000 per year. The hospital will charge the radiology group only $25,000 at first, but increase the charges to $100,000 over four years. Payments are due only if the hospital's gross revenue derived from radiology services exceeds $1,000,000 in the previous year. • The hospital's clinical laboratory, under the direction of the pathology group, would pay the hospital a 20 percent fee for “specimen collection and handling services” when a physician on the MWHC medical staff orders a test from the clinical lab. What advice would you give? Submit this assignment to your instructor via the dropbox “LP6.2 Assignment: Reverse Referral Fees.” This assignment is worth 50 points.The law of health care finance and regulation book Third edition by wolters Kluwer
Explanation / Answer
Aniteust law and referal law- laws are made for the public in ensuring the maintainance of the laws to assure. consumer the low and high quality that flow from competition . antitrust issues are like price of commission fixing,but these are not fixed by law. referal fees are charged to the clients as fees, all these are set and have agrement on it.
in this case of marcus welby hospital , there is subsidary on euipment for home use such as crutches, wheel chair and oxygen concentrator that the subsidary has had certain business practice. sales man regularly offer home health agency employees a "premium" whenever their client order DME from the subsidiary . the subsidiary offer "rebates" to patient who use its equipment. the subsidiary pays hospital and home health agency personal for assisting its patient inlearning how to use its product some arterial blood get test result may have been "massaged" a bit by DME in order to facilliate medicare payment for oxygen concentrator. its good to provide patient with the facilities required by them with the rebates on equipment. so , i would advice there should not be fraudulence cultured just for business purpose and earning money.
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