Is UAB Violating Federal Health-Care Referral Laws?

Two faculty members at the University of Alabama at Birmingham (UAB) recently published an article encouraging neurosurgeons to refer patients to chiropractors for therapy.

The article is curious because one of the UAB faculty members involved has been accused in a whistleblower lawsuit of violating federal laws that govern patient referrals. Also accused in the whistleblower case is attorney Rob Riley (son of Alabama Governor Bob Riley), who joined forces with several UAB health-care providers to form a company called Performance Group LLC.

Central to the lawsuit are allegations that physicians referred patients to an entity, Performance Group, in which they held a "compensation relationship." This would be a violation of the federal Stark Laws, and the lawsuit alleges that Dr. Thomas Spurlock, a chiropractor who is on UAB's neurosurgery faculty, engaged in such activity.

Spurlock helped write an article titled "Socioeconomic Impact of Networking with Chiropractic Providers," which ran in the August 2009 issue of The Journal of Neurosurgery. Spurlock's co-author on the paper was Dr. Mark Hadley, director of UAB's Department of Neurosurgery.

What was at the heart of the research study? The article explains:

A chiropractic clinician was hired to develop, promote, and market a reciprocal referral network between chiropractors and UAB. The network consists of 54 chiropractic clinicians. Review of the database revealed the scope of services provided by the UAB physicians and the hospital. The services provided by each department were categorized and dollar amounts were calculated. Referrals to chiropractic clinicians were recorded.

What did the researchers conclude?

Our results reveal that networking with chiropractic providers has a positive economic impact and the potential for increased economic growth.

That's fine and dandy. But if a physician refers patients to an entity in which he has a compensation relationship, it is a violation of federal law. And that's exactly what the whistleblower lawsuit accuses Spurlock, Riley, and others of doing.

According to the lawsuit, some 20 Alabama defendants purchased ownership interest in Performance Group for the purpose of referring patients and sharing in the profits. Did these physicians include anyone from UAB, perhaps Hadley? The lawsuit does not say, and the Bush-era Department of Justice refused to join the case. But the case can be refiled, and the allegations remain on the table.

Why does this matter? The lawsuit explains the purpose of the Stark Laws:

The Stark Laws (and specifically Stark II, which became effective January 1, 1995) ("Stark"), prohibit physicians from referring Medicare, Tricare, or Medicaid patients to an entity for certain "designated health services," including radiology services, if the physician has a non-exempt "financial relationship," including a "compensation relationship," with such entity. 42 U.S.C. 1395 (nn)(a)(1), (h)(6).

Stark's prohibition is not limited to situations where the physician
directly refers the patient to a particular entity. Stark prohibits a physician from requesting an item or service for a patient which is performed by a provider of a designated health service with which the physician has a compensation relationship.

Entities and persons, such as Defendants, may not present or cause to be presented to Medicare Tricare, or any state Medicaid program claims for services furnished pursuant to a prohibited referral, and Stark II expressly prohibits payments of claims for services rendered in violation of its provisions. 42 U.S.C 1395 (nn)(a)(1), (g)(1).

In short, it's a violation of federal law for a physician to refer a patient to an entity in which he holds a financial interest--or for anyone to cause such a referral to be made.

Public documents, however, indicate that Thomas Spurlock and Rob Riley--perhaps with the help of Dr. Mark Hadley and other UAB physicians--have engaged in such behavior.

Now we have Spurlock and Hadley writing an article that appears to be encouraging other physicians to engage in similar behavior because it has "potential for increased economic growth."

We bet it does. Never mind that it might violate federal law.