decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2006 OIG Advisory Opinions / Opinion 06-22 - Hospital May Reward Surgeons in Cost-Saving Plan
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Article Overview
This premium article reviews an OIG advisory opinion from 2006 concerning a hospital’s proposed cost-saving arrangement with cardiac surgeons. It explains the regulatory and compliance issues the agency evaluated, including civil monetary penalty concerns, Anti-Kickback Statute risk, and safeguards discussed in connection with gainsharing-style arrangements. The piece is relevant to compliance professionals, hospital administrators, physicians, and billing/coding staff who follow fraud-and-abuse guidance.
Why This Topic Matters
Health care organizations use advisory opinions to understand how federal fraud-and-abuse authorities may view financial arrangements that affect clinical practice and hospital operations. This article helps readers assess the broad compliance considerations involved in cost-saving incentive programs without relying on the full advisory opinion text.
Article Sections
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Advisory opinion summary
Overview of the hospital’s proposed surgeon incentive arrangement and the general compliance concerns raised by the arrangement.
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Civil monetary penalty concerns and safeguards
Discussion of the civil monetary penalty issues considered by OIG and the types of safeguards described in the opinion.
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Anti-Kickback Statute concerns and risk-limiting features
Summary of the Anti-Kickback Statute considerations and the general features identified as reducing fraud-and-abuse risk.
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Related resources
Pointer to related discussion of gainsharing and cost-saving arrangements.
What You Will Learn
- The regulatory issues an OIG advisory opinion may address in a hospital cost-saving arrangement
- The broad categories of safeguards referenced in connection with physician incentive programs
- How the article situates the opinion within Anti-Kickback and civil monetary penalty compliance topics
- Where the article points readers for related information on gainsharing-style arrangements
Who Should Read This
- Compliance officers
- Hospital administrators
- Physicians
- Revenue cycle professionals
- Health care attorneys
- Medical coding and billing professionals
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