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| Dear Friend,
As my gift to you, here's a free stay out of jail pass. But it does require a bit of effort on your part.
Instructions
Step 1: Read this short post.
Step 2: Print it out and trim off extra margins.
Step 3: Fold it so that it fits into your wallet.
Step 4: Pull it out and reread it once a week or more often, if needed.
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The chance to get a little something back, a vig, a taste, a cut.
It's a story nearly as old as time itself, but not normally the story one tells oneself. Then, it's usually a "business deal".
Perhaps that's the story that the surgeons who did business with Impartial Medical Experts, LLC (“IME”), told themselves.
The United States government is telling a different story, one that they are alleging in intervening in two whistleblower lawsuits in Massachusetts.
In that intervention, the government’s complaint centers around defendant Kingsley Chin, M.D., described as the founder and Chief Executive Officer of defendant SpineFrontier, a spine device manufacturer. The complaint alleges that Dr. Chin is also the founder and principal owner of defendants KIC Management Group Inc. and KICVentures LLC, which own and operate defendant SpineFrontier and defendant IME of which defendant Vanessa Dudley, Dr. Chin’s wife, was the sole employee.
According to the complaint, the defendants paid spine surgeons over $8 million in sham “consulting” payments ostensibly for product evaluations, when in fact the payments were for use of SpineFrontier devices.
The government claims that the “consulting” spine surgeons were generally paid $500 for a cervical procedure, and $1,000 for a lumbar procedure — but only if the surgeon used SpineFrontier devices — and that the spine surgeons often performed little or no work beyond implanting the devices, for which they were separately paid by carriers, including federal health care programs.
It’s also alleged that the defendants didn’t systematically collect or use feedback from the “consultants” and paid them even when they had provided no feedback at all. Surgeons allegedly could “consult” on SpineFrontier devices in this manner an unlimited number of times so long as they continued using the SpineFrontier product in surgery.
Although the complaint states the names of multiple spine surgeons, none are named as defendants in the action. It's likely that the government will pursue those physicians individually, perhaps criminally, as the story unfolds.
And that's the benefit of keeping this short but sad story in your wallet. Pull it out whenever anyone related to your practice offers to pay you for something. Yes, something as in anything.
Remind yourself that the federal Anti-Kickback Statute (“AKS”) prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by Medicare, TRICARE, and other federally funded programs.
Remind yourself that the AKS doesn't simply support False Claims Act civil claims; it’s a criminal statute, the violation of which leads to actual jail time and large fines.
Remind yourself that, as you read this today and three weeks from today when you remember to pull it out again, that physicians like you are sitting in their cells today and that you don't want to join them.
Treat this clipping as a get out of jail free card and indeed it will be. Or, at least, for slightly more, contact me at markweiss@weisspc.com before you take those consulting fees or accept rent for that closet, or let your spouse take that part-time position as a manufacturer’s rep.
Put this in your wallet. Now. |
| | Tuesday - Success in Motion Video: How to Avoid an Unfair Element of Fair Market Value
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| Let’s talk about fair market value and how to avoid really screwing yourself in connection with fair market valuations.
As you know, FMV is a central concept in healthcare compliance. It’s not the end-all-be-all of compliance, but it's certainly an important element in connection with federal Anti-Kickback Statute analysis, with Stark analysis, and with state counterpart law analyses.
But there’s a very common trap that medical groups and individual physicians fall into in the context of fair market value analysis: It’s providing information to the other side, to the hospital or even to their expert.
Wait. I certainly know that it’s very difficult to have a valuation performed on your services if you’re not going to give up any information. So, I’m not telling you that you’re not going to end up giving them information.
What I am saying is that you must control to whom you give information, the circumstances under which information is given, and the process under which the valuation is conducted.
In other words, there is a negotiation within a negotiation whenever fair market value is an issue.
Don’t let somebody tell you they’re trying to be fair when they’re really trying to screw you.
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| | Wednesday - Medical Group Minute Video: Fast Times and the Problem with Slow Medical Group Decision Making
Watch the video here, or just keep reading below for a slightly polished transcript:
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| We’re living in a time of fast-paced change. Sure. But, I think people have been saying that since the Enlightenment. Maybe it’s the one thing that’s remained constant. But maybe it’s not. Some things have certainly remained the same.
For example, more than seven years ago, in my blog post entitled Who’s Driving Your Practice’s Bus?, published in April 2012, I wrote that for many medical practices, it appears as if no one is driving the bus; that is, no one is in charge of the group’s business. Instead, the practice operates like a runaway bus — yes, the providers are seeing patients, but where is it headed? Instead of a map with a clearly marked final destination, it’s just rolling along.
Many groups have a related problem: There isn’t a bus driver, there’s a whole committee of them. In fact, for some groups, there is a whole Greyhound bus full of them.
There is no question that the healthcare market is changing rapidly. This means that groups must have the ability to make business decisions rapidly.
Drawing on the work of the late Col. John Boyd, considered by many to be the second greatest military strategist to have lived, success requires a faster cycling through what he termed the OODA loop. In simplified form, the loop consists of observing, orienting, deciding and acting. (The OODA loop is actually much more complex with various internal feedback mechanisms). The point, however, is that the competitor who can cycle faster through the loop gains a tremendous strategic advantage over its opponent.
Whether you take the time to study Boyd or not, it’s axiomatic that a group must be able to make decisions quickly. That requires that someone, not some committee, be in charge.
Note that I’m not saying that groups need dictators: far from it. However, group leaders must be empowered to lead – and they must actually lead. |
| | Thursday - Podcast: Deteriorated Insulation from the Hassles of Running a Medical Practice |
| Listen to the podcast here, or just keep reading for the transcript.
If you haven’t read it already, take a quick look at my blog post, Physician Discontent With Hospital Employment Beginning To Boil. In that post, I discuss the epidemic of discontent among hospital-employed physicians. Instead of seeing the outbreak as a negative, my post explores some of the opportunities that this trend presents.
In a subsequent email exchange, my friend Devona Slater of ACE (Auditing for Compliance and Education), commented that she, too, sees the exit of hospital employed physicians as an opportunity. But then she made a very interesting observation, which I’ve edited slightly for presentation: “It’s just part of the cycle of ‘the grass is always greener,’ but, truly, there are weeds in every yard.”
Many physicians opted for hospital employment, some straight from residency and others from independent practice, because they bought the line that hospitals fed them: “You didn’t go to medical school to run a business. We’ll run the business. You get to practice medicine!”
But the word “hospital” means “bureaucracy.”
I’m seeing several interesting trends. Over the past three or four months I’ve worked on four or five consumer focused medicine projects with physicians, both office practice and hospital-based, who were leaving hospital employment. And, I’m beginning to work with internal medicine physicians pulling out of hospital-affiliated clinic settings to establish rather unique group practices.
Certainly, some physicians will remain hospital employees and, for newly minted physicians with an employee mindset, it will continue to be a viable option. That is, until the worsening financial condition of hospitals renders them unable to support employed and affiliated physician groups.
But for most physicians, having to fill in requisition forms, attend moronic meetings, and report to the clinic medical director, who reports to the regional medical director, who reports to the chief medical officer, who reports to the CEO, isn’t exactly hassle free.
Riffing off of Devona’s “weed” analogy, the layers of bureaucracy that were supposedly meant to insulate the doctors from the “hassles of running a medical practice” out hassled the actual “hassles of running a medical practice.” Go figure.
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| | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back
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| In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy here.
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Come listen to Mark speak in sunny
Las Vegas on June 5, 2020, at The Advanced Institute for Anesthesia Billing and Practice Management.
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| | | | | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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