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

2. Contracts

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

13. Types of Contracts Written Verbal Implied by actions
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 With 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