decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Gainsharing Arrangements / OIG_When possible, gainsharing should fit within a Safe Harbor
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Article Overview
This article explains OIG guidance on hospital gainsharing arrangements and why these plans raise concerns under federal fraud-and-abuse rules. It is aimed at compliance staff, hospital administrators, and coding/billing professionals who need to understand the broad compliance issues, the role of the personal services safe harbor, and the types of plan features OIG views as risky.
Why This Topic Matters
Gainsharing arrangements can create compliance exposure for hospitals and physicians if they are not structured carefully. Understanding the general OIG concerns helps organizations evaluate proposed incentive plans and related compliance safeguards.
Article Sections
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OIG compliance guidance on gainsharing
Introduces the OIG’s supplemental hospital compliance guidance and places gainsharing arrangements within the broader fraud-and-abuse compliance context.
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Safe harbor considerations
Summarizes the article’s discussion of safe harbor concepts and why hospitals are encouraged to consider them when structuring gainsharing-related arrangements.
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Warning signs in cost-savings plans
Describes broad features of hospital cost-savings plans that OIG treats as problematic, including concerns tied to plan scope, referrals, and patient selection patterns.
What You Will Learn
- The general compliance concerns associated with hospital gainsharing arrangements.
- How the article frames safe harbor considerations for hospital incentive plans.
- The broad categories of plan features OIG considers warning signs in cost-savings arrangements.
- Which types of organizations and professionals may need to review these compliance issues.
Who Should Read This
- Hospital compliance teams
- Hospital administrators
- Physicians
- Coding and billing professionals
- Healthcare legal and reimbursement professionals
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