A young and dedicated Doctor of Osteopa- thy, Dr. Osso, who specializes in osteopathic pharmacy, an acupuncturist, a massage thera- manipulative treatment (OMT)
Dr. Osso’s New Practice – Case for Chapter 16 J. Brooke Barclay and Ellen Breckenridge A young and dedicated Doctor of Osteopa- thy, Dr. Osso, who specializes in osteopathic pharmacy, an acupuncturist, a massage thera- manipulative treatment (OMT), has just been pist, and a biofeedback practitioner. offered a beautiful, large space to open a pri- Many patients from Dr. Osso’s previous vate practice. Dr. Osso was previously part of practice transferred their care over to the new a large group practice and had no managerial office and word of mouth brought in many new responsibilities. Dr. Tanner, a physician, and patients. This success did not go unnoticed. Hannery Conn, a medical assistant, have just Dr. Tanner soon visited Dr. Osso to follow up opened a pain management clinic in a new on their agreement that Dr. Osso would refer at least 10 patients a month to the pain clinic clinical building they purchased. With the for trigger point injections or start paying a influx of retirement communities in the area, higher monthly rent. Sure enough, embedded there is a growing Medicare population. The in the fine print in the contract was a clause office is an ideal location. Dr. Tanner offered to stating this, although the language was vague rent a spacious office to Dr. Osso for a terrific on the exact terms. To avoid a rent hike, Dr. monthly rent, thinking that Dr. Osso’s practice Osso began referring patients with the most would be very complementary to theirs. Dr. acute localized pain to Dr. Tanner for trigger Osso had never negotiated a real estate con- point injections. tract like this before and breezed through the One of Dr. Osso’s patients, Ms. Hope, fine print. Dr. Osso was required to provide a went to the pain clinic for trigger point injec- client list from the previous practice, so they tions, and at her next appointment with Dr. could be certain Dr. Osso was an established Osso she mentioned that she felt no real pain and well-respected physician and could gener- relief from the red injection that Hannery ate enough revenue to keep up with rent. They gave her, Several other patients recounted assured Dr. Osso that this was for vetting pur- the same thing to Dr. Osso, who became poses only and that the patients would not be concerned that Hannery, rather than Dr. contacted, nor the list shared. Tanner, was giving the Injections, and that The pain clinic offers a variety of thera- Hannery was perhaps not using the correct pies, including trigger point injections. Indeed, trigger point medications, such as anesthetics it was apparent how the various clinicians or cortisone combinations, but was instead injecting the patients with Vitamin B12. The renting in the building had complementary difference in cost was significant: the trigger practice areas, and together provided one-stop shopping, especially for aging patients who point medication was reimbursed by Medi- care at $60 per shot, but Vitamin B12 was suffer from chronic pain. The other tenants in the building included a small independent reimbursed at $0.66 per shot.
474 Chapter 18 Health Care Management Case Studies and Guidelines Ms. Hope also mentioned that the pain 6. Who should report these issues and to medication that Hannery prescribed is doing whom? Is there more than one author- wonders, and Hannery even authorized mul- ity that should be contacted to investi- tiple refills from the pharmacy conveniently gate these matters? located next door. However, Ms. Hope has 7. Who could act as a qui fam relator for begun complaining about new ailments that any of these violations? Explain what she had not previously mentioned, such as information would have to be reported chronic constipation, nausea, and dry mouth. and to whom. Is Ms. Hope perhaps exhibiting signs of an B. What consequences could each party unwitting opioid addiction? face if prosecuted? Include both civil and criminal penalties. Discussion Questions 9. Even though Dr. Osso’s patients could have benefited from the supplemental 1. Which laws or regulations do you trigger point injections, should they think might have been violated in this have been referred to that particular scenario? pain clinic? 2. Which parties in this scenario might 10. If Dr. Osso made referrals to meet the have violated federal or state laws or agreed upon quota, what fiduciary regulations? compromises might have been made to 3. Which violations might be civil, and reach that quota? which might be criminal, too? 11. Although Dr. Tanner and Hannery 4. What was the very first red flag that Conn were following common busi- something in this arrangement was a ness practices in many industries, what compliance problem? could a practice manager for the pain 5. Does Dr. Osso’s inexperience and lack clinic have done to protect against of knowledge protect against liability/ potential compliance problems and accountability? Provide a rationale for huge liability? your response.
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