Self-referral regs prompt second look; physicians' practices and pay likely to be restructured

Article Abstract:

The portion of the Health Care Financing Administration's (HCFA) "Stark II" regulations regulating doctors' financial arrangements with other health care providers bans most self-referrals. The narrowness and ambiguity of the proposed regulation of ancillary services income worries lawyers. Ancillary services are those performed in a doctor's office by someone other than a doctor but under the doctor's control. The HCFA previously did not object to part of the income from such services being allocated to doctors but the latest proposals have a group accounting approach which observers criticize as being not realistic.

Administration of Public Health Programs, Miscellaneous Store Retailers, MISCELLANEOUS RETAIL, Retail Trade NEC, Health Care Financing Admin, United States, Prices and rates, Retail trade, United States. Centers for Medicare and Medicaid Services

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Antitrust defenses in physician peer review cases

Article Abstract:

Substantive defenses and immunities available to defendant hospitals and reviewing physicians have been successful in limiting antitrust claims brought by physicians that have asserted that they were harmed by action resulting from peer review. Plaintiffs have argued that peer review is used by competing doctors as a means of conspiring against the reviewed doctor to injure the doctor and reduce competition. Defendants have successfully questioned the conspiracy and injury to competition elements. Immunity under the Health Care Quality Improvement Act has not been as effective.

Cases, Antitrust law, Professional standards review organizations (Medicine)

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