Congressman
Pete Stark Speaks Out on UnitedHealth's Plan to Fine Physicians
and Condo (Pod) Labs
Since
he first won election to Congress back in 1972, Representative
Pete Stark (D-California) has earned a reputation for straight
talk. That trait was exhibited yesterday during a speech Rep.
Stark delivered at the annual meeting of the American
Clinical Laboratory Association (ACLA) which is taking place
this week in Washington, DC. Your Dark Daily editor was in the
audience and taking notes.
In healthcare, Pete Stark is probably best known as the author
of several bills commonly called the "Stark Laws." These
laws address physician self-referral actions that would trigger
anti-kickback violations. But yesterday, from the ACLA podium,
it was an expansive Rep. Stark—discussing a range of topics
of direct interest to the clinical laboratory industry. In particular,
he touched upon two subjects that relate to anti-kickback situations.
You are likely to find both fascinating and useful.
One subject was his strong reaction to the news that UnitedHealth
Group, Inc. (UNH:NYSE) would fine physicians who referred
laboratory tests to laboratories not holding contracts with UnitedHealth.
He called it “bad news.” “That turns the Stark
Law on its head!” declared Rep. Stark. “What is the
difference between paying some fee to a doctor when he refers
business and fining a doctor who won’t refer to the source
that is providing a discounted service?
“It concerns me,” continued Rep. Stark. “My
sense is that the professional judgment ought to be based on the
best judgment of facts [about the patient’s case]. It ought
not to be based on financial concerns.” Rep. Stark did not
speak further on this point, but his statements reflect concern
about the precedent now being established by UnitedHealth with
its recent willingness to fine doctors as a way to stop leakage
to out-of-network laboratories.
The second topic of particular interest involved anatomic pathology
laboratory condominiums, also known as condo labs or pod labs.
Rep. Stark did not discuss them in detail. Instead, he simply
stated that, “I wait for the OIG decision on pod [condo]
labs.” In my view, that statement demonstrates that Rep.
Stark is alert to ways in which condo/pod labs can circumvent
physician self-referral rules. It is likely that he is watching
for pronouncements by healthcare regulators about the pod/condo
lab matter, and, if necessary, he will take further action to
constrain aspects of condo/pod lab arrangements that are considered
abusive.
Over the 60 minutes that Rep. Stark spoke, it was obvious that
he was familiar and informed about major issues of importance
to the clinical laboratory industry. He touched upon competitive
bidding, condo/pod labs, and how Medicare budget constraints are
likely to influence funding for lab testing services, to name
a few. This is significant, because a legislator must be aware
of lab industry concerns in order to then vote intelligently on
bills that affect these issues. On that point, it was clear that
lobbying and educational efforts by ACLA and other laboratory
professionals have definitely raised Rep. Stark’s awareness
and understanding of the clinical laboratory profession and its
specific needs.
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