decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2007 OIG Advisory Opinions / Opinions 07-21 and 07-22 - Gainsharing Arrangements Will Not Lead to Sanctions
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Article Overview
This summary reviews two 2007 Office of Inspector General advisory opinions involving gainsharing arrangements between a hospital and physician groups. It explains the general compliance and fraud-and-abuse issues the opinions addressed, the broad types of cost-saving measures discussed, and why the arrangements were evaluated for possible sanctions. The article is relevant to healthcare compliance professionals, hospital administrators, physicians, and coding or revenue integrity teams that monitor payment-related risk issues.
Why This Topic Matters
Gainsharing arrangements can raise anti-kickback and patient-care concerns, so advisory opinion summaries like this help readers understand the compliance context and the types of safeguards considered by the OIG.
What You Will Learn
- What gainsharing arrangements are in a hospital-physician context
- Why the OIG reviews these arrangements for fraud-and-abuse risk
- What general categories of safeguards were discussed in the advisory opinions
- How the article frames the relevance of these opinions to compliance review
Who Should Read This
- Healthcare compliance professionals
- Hospital administrators
- Physicians
- Revenue integrity staff
- Coding and reimbursement teams
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