Anesthesia Business Consultants mum over federal investigation involving ‘health care fraud’

Anesthesia Business Consultants spokespeople are mum over an ongoing investigation into allegations of health care fraud a day after federal agents searched the downtown Jackson business.

Agents executed a federal search warrant at the business, officials with the U.S. Department of Health and Human Services Office of Inspector General confirmed Wednesday morning, July 15.

Anesthesia Business Consultants officials would not comment on the investigation Thursday morning, July 16. Media representatives are not allowed in the building, 255 W. Michigan Ave., officials said.

A news release from Anesthesia Business Consultants released about 5:30 p.m. Wednesday said representatives “are cooperating in the collection of the requested information and expect that our full staff in Jackson will resume business as usual.”

“There will be no disruption of service to clients,” the release read.

Federal agents are looking into “allegations of health care fraud, included but not limited to the Medicare program, the Medicaid program and some private insurance companies,” Joseph Napolitano, assistant special agent in charge, said Wednesday.

About 20 agents and 10 forensic specialists imaged computers and seized miscellaneous paper documents. The health care business closed its doors and sent a handful of employees home after the federal agents arrived about 9:30 a.m. Wednesday.

“It’s just an allegation at this point,” he said. “We’ll review the evidence and move on from there.”

Anesthesia Business Consultants employs roughly 300 people in its downtown Jackson offices. The company processes medical billing records before claims are sent to Medicare and Medicaid.

Will Forgrave covers city and county government for the Jackson Citizen Patriot. Contact him at wforgrav@mlive.com or 517-262-7554. Follow him on Twitter at @WillForgrave.

Anesthesia Service Contracting can Raise Compliance Issues; the OIG can Help

Anesthesia practices are more and more feeling that surgical groups or other providers are pushing them into unfavorable financial deals. If you find yourself in this predicament, you have a way to push back by using a recent advisory opinion from the HHS Office of Inspector General (OIG).

 In one OIG reviewed deal, the OIG found that an arrangement between an anesthesia group and a psychiatric group potentially violated the Anti-Kickback Statute and could trigger penalties if the deal went forward, according to Advisory Opinion 13-15. Under the deal, the anesthesia group would provide care for patients of a psychiatric group who were undergoing electroconvulsive therapy (ECT) at the hospital. The anesthesia group would reassign its billing rights for these services to the psychiatric group, which would pay the anesthesia group a fixed, per diem amount and keep the difference between what Medicare paid and the anesthesia group’s fee. The anesthesia group that requested the opinion stated the fixed, per diem amount was well below fair market value. 

The OIG could not give an opinion on whether the payments were fair market value. The OIG’s concern is that the providers will order more services simply because it has a financial incentive to do so. The Psychiatric group would likely dictate the charges to be submitted for reimbursement.

 Even though advisory opinions only apply to the requestor, you should start your deal negotiations by sharing this with the surgical group. Also use Advisory Opinion 12-06. That opinion focused on two fee arrangements with an anesthesia group, which the OIG also found could violate the statute. Tell the group that based on the advisory opinions, you don’t believe a proposed deal is legal.

 Other things to consider:

  1. Review contracts for safe harbor provisions
  2. Inform groups, providers of potential risks
  3. Check contracts for fair market value
  4. Request your own advisory opinion
  5. Insure that personal services & management contracts safe harbor requirements

 Official resources