decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2004 OIG Advisory Opinions / Opinion 04-09 - Employee Safe Harbor Protects Consulting Physician Contracts
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Article Overview
This article reviews a 2004 HHS Office of Inspector General advisory opinion involving a professional service corporation that wants to compensate a physician for consulting services while a patient resides in a nursing home. It explains the compliance context, the role of the employee safe harbor, and the importance of employee-versus-contractor status for fraud and abuse analysis. The piece is relevant to compliance professionals, healthcare attorneys, physician practices, and post-acute care organizations evaluating remuneration arrangements.
Why This Topic Matters
Advisory opinions like this help organizations assess whether care coordination and consulting arrangements may fit within federal fraud and abuse exceptions or safe harbors. Readers can use the article to understand the compliance issues raised by physician compensation structures in long-term care settings.
Article Sections
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Summary of the Advisory Opinion
Overview of the arrangement reviewed by the OIG and the general setting in which the consulting services would be provided.
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Compensation and Billing Structure
Discussion of the payment framework, service expectations, and the article’s description of how charges would be handled.
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Safe Harbor Analysis and Caveat
Explanation of the compliance framework discussed by the OIG, including the significance of employee status and the caution raised about other worker classifications.
What You Will Learn
- The general compliance issues addressed in an OIG advisory opinion involving physician consulting arrangements.
- How employee status can affect analysis under a federal safe harbor framework.
- Why payer billing practices and compensation structure matter in fraud and abuse review.
- The types of healthcare relationships that may raise anti-kickback concerns in post-acute care settings.
Who Should Read This
- Compliance professionals
- Healthcare attorneys
- Physician practice administrators
- Post-acute care organizations
- Coding and reimbursement staff
- Healthcare consultants
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