On Nov. 5, the OIG issued Advisory Opinion 21-15, signing off on a compensation arrangement between a practice and part-time nurse that raised issues of liability for reverse kickbacks. Here’s a look at the Advisory Opinion and what it may portend. The Proposed Arrangement A pain management practice owned by a physician wanted to hire a certified registered nurse anesthetist (CRNA) to deliver anesthesia services to two of its locations on a part-time basis. Under the agreement, the CRNA would reassign his right to receive reimbursement for the services he performs to the practice and get a salary instead. The practice would then bill for all separately billable services the CRNA provided. The question: What if the income from the CRNA’s billings exceeded the salary the practice paid the CRNA for those services? Could the practice keep those excess monies as a profit? Risk 1: Salary Payments to the CRNA The first stream of payments implicating the Anti-Kickback Statute (AKS), which bans offering or receiving anything of value in exchange for referring a Medicare, Medicaid or other federal health insurance patient, was the salary payments from the practice to the CRNA for the ordering and furnishing of anesthesia items and…
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