The Problem of Physician Self-referral Under the Medicare and Medicaid Antikickback Statute: The Hanlester Network Case and the Safe Harbor Regulation

JAMA: The Journal of the American Medical Association

Volumn 268, Issue 1, 1992, Pages 85-91

  Crane, Thomas S ^a,b  

^a U S DEPARTMENT OF HEALTH AND HUMAN SERVICES   (United States)

^b Allen and Snyder LLP   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

FINANCE; HEALTH CARE; HEALTH CARE ORGANIZATION; LEGAL ASPECT; MEDICAL ETHICS; MEDICAL PRACTICE; MEDICARE; PATIENT REFERRAL; PHYSICIAN; PRIORITY JOURNAL; REVIEW;

AMERICAN MEDICAL ASSOCIATION; CLINICAL APPROACH/SOURCE; DEPARTMENT OF HEALTH AND HUMAN SERVICES; FEDERAL GOVERNMENT; FLORIDA; GOVERNMENT REGULATION; HEALTH CARE AND PUBLIC HEALTH; INCENTIVES; INSPECTOR GENERAL V. HANLESTER NETWORK; JUDICIAL ACTION; LEGAL APPROACH; MEDICAID; MEDICARE; MISCONDUCT; PROFESSIONAL ORGANIZATIONS; PROPERTY RIGHTS; UNITED STATES;

FRAUD; HOSPITAL-PHYSICIAN JOINT VENTURES; MEDICAID; MEDICARE; PROFESSIONAL MISCONDUCT; REFERRAL AND CONSULTATION; UNITED STATES;

EID: 0026685037     PISSN: 00987484     EISSN: 15383598     Source Type: Journal    
DOI: 10.1001/jama.1992.03490010087035     Document Type: Article

References (67)

1. 42 CFR §1001.952.56 Federal Register 35952-87.
2. Final Decision on Review of Administrative Law Judge Decision. The Inspector General v The Hanlester Network et al. Dept of Health and Human Services; Departmental Appeals Board; Appellate Division; Doc Nos. C-186 through C-192, C-208, C-213. Dec No. 1275. Reported in Commerce Clearing House Medicare and Medicaid Guide ¶39,566.
3. Decision on Remand of the Administrative Law Judge. The Inspector General v The Hanlester Network et al. Dept of Health and Human Services; Departmental Appeals Board; Civil Remedies Division; Doc No. C-448. Dec No. CR 181. Reported in Commerce Clearing House Medicare and Medicaid Guide, ¶40,064.
4. §1128B(b) of the Social Security Act. 42 USC §1320a-7b(b).
5. Medicare and Medicaid Patient and Program Protection Act of 1987. Pub L No. 100-93, §2 (codified as §1128(b)(7) of the Social Security Act. 42 USC §1320a-7(b)(7)).
6. 54 Federal Register 3090.
7. 56 Federal Register 35958.
8. 56 Federal Register 35966.
9. Gray BH, ed. For-Profit Enterprise in Health Care. Washington, DC: Institute of Medicine, National Academy Press; 1986.
10. Office of Inspector General. Financial Arrangements Between Physicians and Health Care Business. Washington, DC: Office of Inspector General, Dept of Health and Human Services; May 1989.
11. State of Florida Health Care Cost Containment Board. Joint Ventures Among Health Care Providers in Florida. Tallahassee, Fla: State of Florida Health Care Cost Containment Board; September 1991:vol 2.
12. Relman AS. Dealing with conflict of interest. N Engl J Med. 1985;313:749-751.
13. Deficit Reduction Act of 1984. Pub L No. 98-369, §2303 (codified as §1833(h)(5)(A) of the Social Security Act. 42 USC §1395l(h)(5)(A)).
14. Omnibus Budget Reconciliation Act of 1987. Pub L No. 100-203, §4051 (codified as §1842(n) of the Social Security Act. 42 USC §1395u(n).
15. Starr P. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. New York, NY: Basic Books; 1982.
16. Gray BH. The Profit Motive and Patient Care: The Changing Accountability of Doctors and Hospitals. Cambridge, Mass: Harvard University Press; 1991:111-151.
17. Hillman BJ, Pauly MV, Kerstein JJ. How do financial incentives affect physicians’ clinical decisions and the financial performance of health maintenance organizations? N Engl J Med. 1989;321: 86-92.
18. Hemenway D, Killen A, Cashman S, Parks CL, Bicknell WJ. Physicians’ responses to financial incentives. N Engl J Med. 1990;322:1059-1063.
19. Hillman BJ, Joseph CA, Mabry MR, Sunshine JH, Kennedy SD, Noether M. Frequency and costs of diagnostic imaging in office practice: a comparison of self-referral and radiologist-referring physicians. N Engl J Med. 1990;323:1604-1608.
20. State of Michigan, Dept of Social Services. Utilization of Medicaid Laboratory Services by Physicians With/Without Ownership Interest in Clinical Laboratories. Lansing, Mich: State of Michigan, Dept of Social Services; July 9, 1981.
21. Blue Cross and Blue Shield of Michigan, Medical Affairs Division. Comparison of Laboratory Utilization and Payout to Ownership. Detroit, Mich: Blue Cross and Blue Shield of Michigan, Medical Affairs Division; May 9, 1984.
22. Health Care Financing Administration, Region V, Division of Health Standards and Quality. Diagnostic Clinical Laboratory Services in Region V. Washington, DC: Health Care Financing Administration, Dept of Health and Human Services; May 1983. Report 2-05-2004-11.
23. §1877(f) of the Social Security Act. 42 USC §1395nn(f).
24. §§1833 (q)(1) and 1877 (h)(5) and (7) of the Social Security Act. 42 USC §§1395l(q)(1) and 1395nn(h) (5) and (7).
25. Inspector General’s Post-Hearing Brief. The Inspector General v The Hanlester Network et al. Dept of Health and Human Services; Departmental Appeals Board; Civil Remedies Division, Doc Nos. C-186 through C-192, C-208, C-213, pp 127-128,199-200. November 20, 1990.
26. Letter from Bureau of Competition, Federal Trade Commission, to Inspector General Richard P. Kusserow, December 18, 1987, regarding safe harbor regulations under consideration.
27. Arquit KJ, director, Bureau of Competition, Federal Trade Commission. A new concern in health care antitrust enforcement: acquisition and exercise of market power by physician ancillary joint ventures. Presented at the National Health Lawyers Association; January 20, 1992; Washington, DC.
28. Perry L. Physician ownership may give hospitals a shot in the arm. Mod Healthcare. June 30, 1989:25-28.
29. Freudenheim M. Cashing in on health care’s troubles. New York Times. July 2, 1991:sec 3:1.
30. Decision of the Administrative Law Judge. The Inspector General v The Hanlester Network et al. Dept of Health and Human Services; Departmental Appeals Board; Civil Remedies Division; Doc Nos. C-186 through C-192, C-208, C-213. Reported in Commerce Clearing House Medicare and Medicaid Guide ¶39,094.
31. See, eg, Key Enterprises of Delaware v Venice Hospital, 919 F2d 1550, 1556-60 (11th Cir 1990) (unlawful channeling of patient choice).
32. Findings of Fact and Conclusions of Law 262.
33. Findings of Fact and Conclusions of Law 165.
34. Findings of Fact and Conclusions of Law 190.
35. Findings of Fact and Conclusions of Law 164.
36. 56 Federal Register 35954.
37. Thornton DM, Crane TS. Briefing by the Office of Inspector General, Safe Harbor Regulations. August 6, 1991.
38. 42 CFR §1001.952(a)(1). 56 Federal Register 35984-85.
39. 42 CFR §1001.952(a)(2). 56 Federal Register 35984-85.
40. 42 CFR §1001.953. 56 Federal Register 35969, 35987.
41. 56 Federal Register 35964.
42. 42 CFR §§1001.952(a)(2)(ii)-(v), (vii), (viii). 56 Federal Register 35967-71, 35984-85.
43. 56 Federal Register 35967 (all active investor safe harbor).
44. 42 CFR §§1001.952(a)(2)(ii), (iv), (v). 56 Federal Register 35968-69, 35984.
45. Kelly TL. Summary and analysis of the final Medicare and Medicaid ‘safe harbor’ regulations. Dimens Health Care. 1992;92:1.
46. Health Lawyers News Rep. 1992;20(1):1.
47. Himmelstein L. Health law gets hot. Legal Times. 1992;14(39):1,18.
48. Internal Revenue Service. General Counsel Memorandum 39862. November 22, 1991.
49. Internal Revenue Service. Exempt Organizations Examination Guidelines Handbook, §333: Hospitals. Washington, DC: Internal Revenue Service; March 27, 1992. Manual transmittal 7(10)69-38.
50. Internal Revenue Service. Advance announcement 92-70. April 21, 1992.
51. Report of the American Medical Association Council on Ethical and Judicial Affairs; Report C (1-91). December 11, 1991.
52. Council on Ethical and Judicial Affairs, American Medical Association. Conflicts of interest: physician ownership of medical facilities. JAMA. 1992; 267:2366-2369.
53. 56 Federal Register 35973 (per-use or per-procedure rent or compensation arrangements).
54. 56 Federal Register 35978 (discounts on packages of similar items).
55. 56 Federal Register 35971.
56. 56 Federal Register 35959-60.
57. Letter from Inspector General Richard P. Kusserow, Dept of Health and Human Services, to Rep J.J. Pickle, March 13, 1992.
58. §1128A(a) of the Social Security Act. 42 USC §1320a-7a(a).
59. 31 USC §3730(b).
60. The Omnibus Reconciliation Act of 1989. Pub L No. 101-239 §6204(a) (codified as §1877 of the Social Security Act. 42 USC §1395nn).
61. Greenberg DS. Mamon and medicine. Lancet. 1991;338:1067-1068.
62. HR 3837, 102d Cong, 1st Sess (1991).
63. The President’s Comprehensive Health Reform Proposal. Washington, DC: US Government Printing Office; February 6, 1992:68.
64. New Jersey Revised Statute, §45:9-22.5.
65. Nevada Revised Statutes, §630.305.
66. 1992 Fla Laws, chap 92-178.
67. Relman AS. Shattuck Lecture: The health care industry: where is it taking us? N Engl J Med. 1991;325:854-859.