Eyeworld

EW INTERNATIONAL 66 August 2016 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer by a pharmaceutical company and receives not only reimbursement for travel and congress fees but for social events is considered profiting and according to the new corruption laws, culpable. Where the law draws the line here is still unclear and so somewhat open to interpretation. Physicians have asked for fur- ther clarification about being spon- sored by companies to teach courses or hold presentations at congresses for CME, as payment in such cases is for their service as part of an educa- tional event and not a promotion of their own product. Another gray zone that was discussed was device sharing. Often medical devices are too costly an investment for an individual phy- sician. Now physicians are not sure whether the referral of patients for an examination to a partner with whom he shares devices will evoke suspicions of patient feeding. Coop- erating with partners is encouraged on the one hand, but not to be over- done. German lawmakers are trying to achieve impartiality and insist on a balance between performance and reward. Michael Knorz, MD, in private practice, Mannheim, Germany, elucidated that profitable deals were not meant to be fraudulent. A good deal with a medical supplier does not preclude top-notch patient care, intended with the patient's best interest in mind. "Doctors have to earn their living, too. They don't en- gage in business to deceive anyone. The intention is to best serve their patients and to earn," he said. In spite of the restrictions imposed by the new German laws, doctors will adapt and restructure their businesses as needed, the bottom line being the welfare of the patient. A good guideline according to Dr. Knorz is, "If the motivation for a cooperation is for the patient's advantage, then it should and will be done. Once you stand to profit from your decision in any way, it needs to be reconsidered." EW Editors' note: The physicians have no financial interests related to their comments. Contact information Badle: presse@gsta.justiz.hessen.de Knorz: knorz@eyes.de Weidhaas: rechtsanwalt@weidhaas.de of 300 billion, which some fear may be sorely affected by the new laws. German doctors want clear rules that they can understand without a law degree. Rüdiger Weidhaas, a criminal lawyer in Bad Dürkheim who spoke at the DOC, advised ophthalmologists to seek legal council to assist them in a thorough examination of their on-going office cooperations and to make sure new contracts are free and clear of impli- cation. "The terms used in the writing of the laws are not clearly defined, nor are they specific about the breadth of offenses and penalties. This will lead to misinterpretations. Also, the regionally varying pros- ecution practices, especially with respect to health care, will lead to an inequitable implementation of the law in different German states. I would advise physicians to critically examine their business contracts. Cooperations that are contrary to trade laws will now have conse- quences," Mr. Weidhaas said. Transparency A key feature of the new laws is the importance placed on maintaining professional independence in all decisions made for the good of the patient, without temptations that might influence that decision. Ger- man physicians think that achieving transparency is the best way to go right now, but given the many sides of business agreements, the answers to their questions are not clear. A blurry gray zone, for instance, that has emerged in the wake of the new corruption laws relates to con- gress invitations. A doctor who at- tends a congress that is compensated market, drive prices up, and under- mine patient trust, he said. Bribes and bribery Legally, profit is defined as any transaction that objectively im- proves a person's financial or per- sonal situation. According to laws 299a/b, bribes/bribery constitute any financial profit made by a physi- cian, his family members, or third parties by exacting payment, being promised or accepting payment, or offering/awarding payment. The new laws prohibit the gainful coop- eration with a supplier that is cho- sen on the basis of personal profit, such as for prescribing or dispensing medications or medical aids, buying/ selling of medical products, and feeding patients to partners under the blanket of referrals. "Doctors will be criminally prosecuted for accepting or offering bribes. We expect to see an increase in the numbers of complaints filed by competitors and former office employees. The severity of the penalties imposed will vary in accordance with the crime, but the manner in which law enforcement will choose to deal with individual cases remains to be seen," Mr. Badle said. Bad for business Germany's new hard line threatens up to 5 years of imprisonment for corrupt health care professionals, has dampened the business climate, and wreaked uncertainty among those affected by the new laws, who also include physical therapists, op- tometrists, and more. The German health market boasts yearly revenues Tougher new German laws that aim to cut out bribery and kickbacks in the health care system were the topic of much discussion at the 2016 Congress of German Ophthalmic Surgeons A business deal struck be- tween a physician and a medical supplies com- pany is a fairly routine occurrence, beneficial to both the supplier who makes the sale and the physician who is of- fered, for instance, a lucrative agree- ment in which he might receive more product at reduced cost, in exchange for the contract. Accord- ing to the new punishable offenses §§299a and 299b of the German Penal Code, physicians accused of accepting or offering bribes and/or kickbacks can face high fines and jail sentences of up to 3 and in some cases 5 years. Anti-corruption legislature The new laws that target doctors in private practice took effect in June 2016 and were the subject of much discussion at the 29th International Congress of German Ophthalmic Surgeons (DOC), where a mostly legal panel discussed the implica- tions and repercussions of the law's tougher stance. "German lawmakers decided it was time to plug a loophole in the health care system that they believe was detrimental to the competi- tive market environment. The laws have not changed, as such, but now they carry a criminal penalty," said Alexander Badle, chief prosecutor of the Hessian Center for the Pro- tection Against Property Offenses and Corruption in the Health Care System in Frankfurt, during a talk at the DOC. Mr. Badle explained that now German private practitioners may be criminally prosecuted and penal- ized for any income related to their medical practice that was not earned through their expertise as a medical doctor. Gainful associations between physicians and pharmaceutical or medical supply companies are seen as corrupt because lucrative deals impair the competitive medical New German anti-corruption laws will affect physicians despite lack of clarity Presentation spotlight

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