decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2001 OIG Advisory Opinions / Opinion 01-01 - Hospital May Gainshare With Cardiac Surgeons
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Article Overview
This summary reviews an OIG advisory opinion about a hospital gainsharing arrangement with cardiac surgeons and the compliance issues it raised under federal fraud-and-abuse and physician self-referral laws. It is relevant to hospitals, surgeons, compliance teams, and healthcare attorneys who monitor advisory opinions, care coordination incentives, and patient-protection safeguards.
Why This Topic Matters
The article shows how OIG evaluated a hospital's proposed cost-savings arrangement for risk, transparency, patient care impact, and program integrity. Readers looking at physician incentive structures and fraud-and-abuse compliance can use it to understand the kinds of safeguards and concerns addressed in an advisory opinion context.
What You Will Learn
- What types of hospital-physician cost-savings arrangements may raise federal compliance concerns.
- How OIG evaluates patient care protection, transparency, and program integrity safeguards.
- Why advisory opinions can be important for hospitals and surgeon groups considering gainsharing models.
- What fraud-and-abuse and physician self-referral laws may be implicated by such arrangements.
Who Should Read This
- Hospitals
- Surgeons
- Cardiac surgery practices
- Healthcare compliance officers
- Healthcare attorneys
- Revenue integrity professionals
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