Physician administrative agreements are complex largely because of the challenging compliance regulations they must follow. Based on the thousands of agreements we’ve read on behalf of our clients, there is a cycle taking place where the agreements are getting more complicated as the compliance landscape becomes more rigid. This can create a series of problems when it comes to writing and managing these agreements over time. Take a read through the physician contracting errors that we’ve seen throughout agreements that can cause both short and long-term problems.
The regulatory environment is deep with rules governing how healthcare organizations (HCO) behave. One particularly strict law is the Stark Law, governing how HCOs interact with referring physicians. The law prevents HCOs from paying physicians unless a safe harbor is met. Assuming the HCO takes proper care in setting up this agreement, problems can still arise in how the agreement is operationally managed over time. If not followed exactly as written, the organization may fall outside the safe harbor rendering the organization in violation. Because the law is non-intent based, the OIG will not be swayed if the HCO inadvertently violates the law. Meaning, even if there is a technical violation of the law, the full wrath of the law applies.