You Make the Call: Self-Disclosing Non-Compliant Arrangements with Large Physician Groups

SITUATION

Fictional Med (FM), a large physician-owned clinic, is one of your lab’s biggest customers. So your heart sinks when during an internal compliance audit, you discover that your lab has been paying service fees to FM physicians at above market rates for years. Immediately recognizing that this constitutes an improper financial relationship, you persuade lab management to disclose the arrangement under the CMS Voluntary Self-Referral Disclosure Protocol (SRDP).

THE DISCLOSURE PROCESS

On June 1, 2017, CMS revised the SRDP process governing how would-be disclosers supply information involving financial relationships with physician organizations and the individual physician owners deemed to “stand in the organization’s shoes.” Specifically, you must fill out a series of specific forms, including the Physician Information Form (PIP Form) listing identifying information about each physician included in the disclosure (i.e., FM).*

THE QUESTION

Do you really have to submit a separate (and redundant) PIP Form for each FM owner?

THE ANSWER

No, as long as you follow the CMS’s new streamlined submission process.

THE EXPLANATION

In an apparent effort to reduce redundancy, CMS published a new FAQ on its website in October to clarify that disclosing entities may submit a single PIP Form covering the entire physician organization, provided that they include a separate listing providing the following information for each physician that stood in the organization’s shoes during the look back period:

• Each physician’s name and National Provider Identifier (NPI);

• The period of noncompliance for the physician with regard to the improper compensation arrangement disclosed; and

• Any other information unique to the physician, e.g., the date the physician became an owner or left the group.

Note:
* The other required SDRP forms include the Financial Analysis Worksheet identifying potential overpayments based on a six-year look back period; and the SRDP Disclosure Form listing identifying information about the disclosing party (in this case, the lab).