Posted: February 22nd, 2016

Best Health Care intends to provide limited primary care services in pharmacy chain stores and possibly other retail stores.

The assignment is about a trend of locating health care service within a retail store, in this cases a pharmacy. See attached article (Post-Gazette Article.pdf; Washington Business Journal Article.pdf.). The assignment should be written from the perspective of a Chief Compliance Office (CCO) of Best Health Care Systems LLC.
Scenario
Best Health Care intends to provide limited primary care services in pharmacy chain stores and possibly other retail stores. The CEO of Best Health Care wants to make sure that the company is not embarrassed by a federal investigation or, worse, a criminal prosecution. He wants all of the financial arrangements to be as “bullet proof” as possible. The CCO may assume that Best Health Care will operate in a manner similar to the arrangement described in the article and should also assume that all the patients seen by Best Health Care’s clinics are covered by a federal health care program for the services rendered.
1. Best Health Care plans to lease space for its clinic operations within the premises of a retail pharmacy. What advice would you give regarding the terms of a Best Health Care lease with the pharmacy? Would your advice for leases with pharmacy chains such as Walgreen’s and Rite Aid be different than for leases with other retailers such as Home Depot, Menard’s, Lowe’s, and similar? Why?
2. Best Health Care will staff its retail store-based clinics with licensed nurse practitioners. However, Best Health Care wants to have a physician available to consult with the nurse practitioner as needed. The CEO informs you that the company will pay one or more local physicians (depending on local needs) a fixed fee for each telephone consultation with a nurse practitioner. Consultation fees will be negotiated individually with each physician before they sign on to provide the consultative services. The CEO advises that physicians have been eager to sign up to provide consultations because the patient is likely to be referred to the physician for any follow-up care needed after the visit to Best Health Care’s clinic. The CEO wants to know how to best protect the compensation arrangement with the physicians from challenge under the federal anti-kickback statute and, in particular, if the arrangement as proposed can be protected by a “safe harbor” to the anti-kickback statute. Is a safe harbor available? If so, which one? If not, why not? What alternative physician compensation arrangement(s) might you recommend? Explain and give reasons for your conclusions.
3. Best Health Care would like to give patrons of its retail-based clinics a $5 coupon at every visit to the clinic. The coupon could be used for purchases of goods at the pharmacies/retailers where clinics are located. Does this proposal present any civil monetary penalty or other “kickback” risk to Best Health Care? Why or why not?
4. The CEO would like to obtain an OIG advisory opinion concerning the coupon plan. Describe the advantages and disadvantages of seeking an advisory opinion in this particular case.

Resources: The attached document and the OIG website, www.oig.hhs.gov. And support answer with reasons and, where applicable, citations to OIG publications or other authority.