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Bhagwan Satiani

Publications and source records attributed to Bhagwan Satiani.

14 recordsLinked to original sources
PubMed2006

Exceptions to the Stark law: practical considerations for surgeons.

BACKGROUND: The purpose of this study was to provide an understanding of the applicable legislative exceptions to prohibitions under the Stark law, which governs common legitimate business relationships in surgical practice. METHODS: Stark I and II prohibits all referrals (and claims) for the provision of designated health services for federal reimbursement if a physician or immediate family member has any financial relationship with the entity. Regardless of intent (unlike the antikickback statute), any financial relationship is illegal unless specifically excepted by statute. These exceptions are relevant to ownership, compensation arrangements, or both. The most important ones relevant to surgeons are as follows: physician service exception (services rendered in an intragroup referral); in-office ancillary services exception (office-based vascular laboratory); the whole hospital exception (ownership interest in a hospital or department); lease exception (conditions that must be met for a lease not to be considered illegal); bona fide employment exception (important to academic medical centers); personal services arrangement exception (vascular laboratory medical directorship); physician incentive plans exception (if volume or value of referrals are an issue); hospital-affiliated group practice exception (physician services billed by a hospital); recruitment arrangement exception (inducements by hospitals to relocate); items/services exception (transcription services purchased from a hospital); fair market value exception (covers services provided to health care entities); indirect compensation arrangements (dealings between a hospital and entity owned by physicians); and academic medical centers exception (new phase II rules broaden the definition of academic medical centers and ease the requirement that practice plans be tax-exempt organizations, among other changes. CONCLUSIONS: Although expert legal advice is required for navigation through the maze of Stark laws, it is incumbent on surgeons in private practice and at academic centers to have basic knowledge of exceptions under this burdensome statute. Antikickback "safe harbors" provide some protection against possible Stark violations. Penalties for violating Stark laws are severe, including fines of up to $15,000 per service and the economic threat of exclusion from participation in federal health care programs.

Academic Medical Centers↗
PubMed2004

Business knowledge in surgeons.

BACKGROUND: Surgeons and residents in training receive little, if any, formal education in the economic side of clinical practice during medical school or residency. As medical professionals face shrinking reimbursement, loss of control over health care decisions, and limited resources, surgical specialties must reevaluate the need to teach their members business survival skills. Before designing business related-teaching modules, educators must know the exact gaps in knowledge that exist among surgeons. METHODS: This article reports a survey of 133 surgeons in the Midwest who were asked to rate their knowledge base in 11 business topics relevant to the practice of medicine. RESULTS: The survey showed that the average surgeon perceives himself or herself to be poorly equipped to understand basic financial accounting principles, financial markets, economics of health care, tools for evaluating purchases, marketing, budgets, antitrust and fraud and abuse regulations, and risk and return on investments. CONCLUSIONS: Armed with this data, teaching faculty, health care systems, and medical specialty societies should design business education seminars to better position surgical specialists and trainees to communicate with insurers, hospital administrators, health care organizations, and their own personal financial advisors.

Accounting↗
PubMed2004

Superficial venous thrombosis of the lower extremities: analysis of risk factors, and recurrence and role of anticoagulation.

Superficial venous thrombosis (SVT) of the lower extremities is a common ailment seen in outpatient offices of vascular medicine and surgery practices. This study of 60 consecutive outpatients was carried out to examine the incidence of concomitant deep venous thrombosis (DVT), risk factors associated with SVT, recurrence of SVT and/or new DVT, and the role of anticoagulant therapy in the prevention of recurrence. Concomitant SVT and DVT (13%) were significantly less likely to be present in patients with varicose veins as compared to patients without varicose veins (p < 0.04) and more likely to be present in patients with a previous history of DVT (p < 0.02). Fifteen patients (25%) developed either recurrent SVT or new DVT, with two patients developing both SVT and DVT. The absence of varicose veins and the presence of a hypercoagulable condition (n = 12) appeared to influence the development of new DVT but not the recurrence of SVT. Recurrent SVT was much more likely in patients with thrombosis of the tributaries (p < 0.0008). New DVT was seen significantly less frequently in patients on anticoagulants (p < 0.02).

Adult↗
PubMed2003

Anti-kickback laws and safe harbor protections: brief review for surgeons.

The objective of this review is to provide surgeons basic knowledge regarding the Anti-kickback Statute (AKBS) and safe harbors available for legitimate business activities. The rising costs associated with fraudulent activities have led Congress to demand accountability, fiscal responsibility, and reduction of error rates. To deter and prosecute fraud and abuse, the government currently has available an array of civil and criminal remedies, supported by a number of statutes, investigated by multiple agencies and enforced by the Department of Justice. One such statute is the AKBS. This law makes it a crime to exchange any remuneration for patient referrals. Congress has also issued 23 "safe harbors", which are activities that are protected from prosecution and allow physicians to participate, invest, recruit, joint venture, and refer patients under certain conditions. It is necessary for surgeons to have some knowledge of the AKBS, as well as the various safe harbors provided by the legislature, for lawful business relationships.

Fraud↗
PubMed2003

Relevance of federal antitrust statutes to clinical practice.

With the advent of Medicare prospective payment systems, health care entities and physicians were forced to decrease expenses by sharing services and to increase revenue by attempting to jointly negotiate better reimbursement from third- party payers. Both activities have raised the specter of prosecution under antitrust laws that have been with us for more than a century but are poorly understood by practicing physicians. Recent monopolistic activities in the health care arena have prompted the Federal Trade Commission to file actions under specific acts of Congress, eg, the Sherman Anti-Trust Act, Clayton Act, Federal Trade Commission Act, Robinson-Patman Act, and Celler-Kefauver Act. Inasmuch as it is likely that specialties such as vascular surgery as a business will undergo substantial transformation, physicians need to be aware of the severe civil and criminal sanctions imposed if they are found guilty; fines that are several times actual damages; activities that raise antitrust issues including utilization review, medical staff privileges for competing specialties, participating provider agreements, and predatory pricing; and affirmative defenses and relief available in terms of specific exemptions. As health care providers react, innovate, and adjust to stay solvent, their business strategies will surely continue to be scrutinized for antitrust behavior by federal and state officials. The physician must have a basic understanding of the groundrules that govern any contemplated business strategy so that common pitfalls may be averted.

Antitrust Laws↗
PubMedDate not supplied

Expert witness testimony: rules of engagement.

Overlooked in most legislative remedies to address the medical malpractice (MMP) crisis is stringent prohibition against the use of "junk science'' in the courtroom and defining the qualifications of an expert witness. Expert witnesses should be required to: (1) to disclose information materially related to the reliability of expert testimony. (2) Filing of a "Daubert brief'': a summary of the plaintiff's expert's opinion along with a resume outlining his/her knowledge, skill, experience, training and education, reputation in the field relevant to the litigation, and complete details of the methodology employed by the expert. (3) An oath or declaration that acknowledges the duty to disclose to the court all information known to the person to be material to the reliability of the expert witness. Rules of evidence: The "Frye test'' or the "general acceptance rule'' has been used by judges to exclude expert testimony unless it is "sufficiently established to have gained general acceptance in the particular field in which it belongs.'' Stricter standards need to be legislated at the state level. The mandatory use of scientific panels by judges in all MMP cases is needed. Legislative relief has been sought by the medical community to address the serious disconnect between negligence and MMP litigation. The use of junk science in the courtroom remains largely unaddressed in the judicial system. Medical societies and legislatures must act to define an expert witness and restrain plaintiff's attorneys from using junk science to influence juries.

Expert Testimony↗