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Legal Issues in Anesthesia 2014 Jan Mannino, CRNA, JD Laguna Niguel, CA.

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Presentation on theme: "Legal Issues in Anesthesia 2014 Jan Mannino, CRNA, JD Laguna Niguel, CA."— Presentation transcript:

1 Legal Issues in Anesthesia 2014 Jan Mannino, CRNA, JD Laguna Niguel, CA

2 Contracts

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12 Introduction Terms of relationship defined Legal remedy if breached Perception of business approach to practice

13 Types of Contracts Written Verbal Not appropriate for some transactions, such as real estate More difficult to prove Implied by actions

14 Parts of a Contract

15 Identification of parties CRNA or Business Entity Hospital, Surgeon, etc.

16 Dates Starting Ending Term

17 Termination Clause Notice of termination without cause Usually 3 months Effectively a 3 month contract With cause Specific relating to loss of licensure or serious issue

18 Due Process Not usually given to CRNAs through medical staff policies Have clause in contract that gives you due process rights in clinical issues Protection of practice

19 Exclusive Contract May be important if you are relocating Could have some anti-trust components Make sure you can fulfill obligations

20 Non-Compete Clause Geographic component Time Component Viewpoint of CRNA Viewpoint of Hospital/Group

21 Compensation Part of every contract May be addendum to contract Clear and not open to interpretation

22 Contract for Anesthesia Services What hospital/facility will provide Time obligation Clinical Services Administrative Services Assignment of cases

23 Contract for Employment Salary Benefits Time commitment Services to be performed

24 Antitrust and Anesthesia

25 Joint Conduct Section 1 of the Sherman Act Contracts, combination or conspiracy in restraint of trade is unlawful Elements Agreement Harm to competition

26 Define a relevant market Substitutability Product or service Geography

27 Agreements among competitors Price fixing Division of customers Market allocation

28 Unilateral Conduct Attempts to monopolize Actual monopolization

29 Anticompetitive Conduct Predatory pricing Raising barriers to competitors (Michigan BCBS)

30 Specific antitrust issues in healthcare Staffing and privileges Exclusive contracts Joint negotitaitons with payors Information sharing Packaged pricing

31 Exclusive Contracts Market forces prevail

32 Many Anesthesia Antitrust Cases

33 Billing Issues OIG Advisory Opinion 12-6 See text of opinion in handouts

34 False Claims Act Encourages whistleblowers to report fraud UCI situation Anesthesia records signed before the cases Improper supervision ratios of residents and CRNAs Settlement for $1.200,000 Whistleblower received $120,000

35 Sutter Health Anesthesia Fraud Double billing by hospital for anesthesia services Anesthesia fees posted on website Civil suit filed by Rockville Recovery Associates Anesthesia billing audit firm Settled for $46,000,000 California Department of Insurance

36 Sutter Health Anesthesia Fraud Hospital anesthesia charges $1610 for first half hour $ for each subsequent 15 minutes Not the professional fee

37 Vanderbilt University Surgery schedules showed surgeons were booking simultaneous cases in different parts of the hospital Anesthesia billing issues with supervision Recent openings at Vanderbilt

38 Future Concerns Corporate practice of anesthesia More fraud investigations Data driven practice Middle management more control More businesses making money off of anesthesia services More levels between the anesthesia professional and the patient

39 Thank you UNF Other faculty members Audience


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