Combined capitation/FFS deals may raise red flag
Health plans with combined capitation and fee-for-service arrangements are more vulnerable to federal anti-kickback prosecutions, said Bruce Fried, former director of the Health Care Financing Administration Center for Health Plans and Providers, and now a partner at the Washington, DC law firm of Shaw, Pittman, Potts & Trowbridge.
At particular risk are providers and plan administrators who try to steer beneficiaries to a particular capitated plan or fee-for-service arrangement, said Fried, who addressed the recent National Symposium on Health Care Enforcement. Those physicians "lured by the siren song of heightened revenues" to be gained by deliberately directing healthier beneficiaries to a capitated arrangement and sicker beneficiaries to fee-for-service simply to increase reimbursements can expect to detected and "go to jail," warns Fried. "The potential for misstep and liability is enormous."
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