Physician Relationship Audit Workshop
Anna M. Grizzle, Partner, Bass, Berry & Sims PLC
LeToia Crozier, Chief Compliance Officer, Emdeon
April 22, 2015
Physician contracts are often overlooked or thought to be a small part of compliance's role however, with Stark law, the Anti-Kickback Statute, and the False Claims Act, the stakes are too high not to pay attention. Every year there has been an increase in the number of specifically physician relationship cases like Tuomey.
The first step of a physician contract audit is to locate all of your physician contracts. You may have them all in a centralized database--this is great. However, you may still find contracts that are not centralized. The first step is to update or create this database. While some MD Ranger subscribers use a formal contract management system, some subscribers use their MD Ranger online portal to centralize all of their physician contracts. Gather supporting data for the contracts like FMV information, time records and logs, general ledger accounts, and accounts payable records.
Then, dive in. Analyze each and every contract and the supporting information. Work to determine:
- Is there a written agreement?
- Is there a time commitment outlined?
- Has the agreement expired?
- Is the agreement FMV and commercially reasonable?
- Has the FMV and commercial reasonableness been reviewed in the last two years?
- Are the parties complying with the terms?
- Does the agreement comply with a Stark exception?
Pay special attention to "stacked" arrangements--physicians who have several contracts which independently are FMV and commercially reasonable but when accumulated together, are masking overpayments. Without a centralized database of contracts, these will likely be overlooked.
While nobody attending this session had a similar policy, the speakers recommended a blanket policy where if a proposed physician payment is above the median or 75th percentile, you must obtain an outside opinion. In our subscribers' experience, this type of policy not only creates consistency across services, but actually reduces the number of high payments due to requiring an extra step.
Further analysis on each contract can include:
- Are duties listed being performed?
- Are payments linked to contracts?
- Does the agreement comply with regulations?
- Are time sheets being submitted?
- Is documentation of space utilization available?
- How is non-monetary compensation being tracked?
For the suggested steps to take once you identify issues, read part two.