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

Contracts

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

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

Parts of a Contract

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

Dates Starting Ending Term

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

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

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

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

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

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

Contract for Employment Salary Benefits Time commitment Services to be performed

Antitrust and Anesthesia

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

Define a relevant market Substitutability Product or service Geography

Agreements among competitors Price fixing Division of customers Market allocation

Unilateral Conduct Attempts to monopolize Actual monopolization

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

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

Exclusive Contracts Market forces prevail

Many Anesthesia Antitrust Cases

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

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

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

Sutter Health Anesthesia Fraud Hospital anesthesia charges $1610 for first half hour $457.50 for each subsequent 15 minutes Not the professional fee

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

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

Thank you UNF Other faculty members Audience