decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Gainsharing Arrangements / Prohibition covers hospitals and physicians
Subscribe or sign in to view the full article.
Article Overview
This article explains a federal fraud-and-abuse compliance topic involving hospitals, physicians, clinical joint ventures, and managed care plans. It summarizes the general enforcement concerns discussed by the Office of Inspector General and highlights the types of arrangements and legal frameworks that may be implicated. The piece is useful for compliance staff, hospital administrators, physician groups, and revenue cycle or legal professionals reviewing risk in shared-savings or incentive-based arrangements.
Why This Topic Matters
Gainsharing and related arrangements can create compliance risk for hospitals and physicians when payment structures may affect clinical decision-making or referral patterns. Understanding the scope of the concern helps organizations assess whether an arrangement may implicate federal fraud-and-abuse laws and related penalties.
What You Will Learn
- The general compliance issues raised by gainsharing arrangements in hospital-physician relationships.
- How clinical joint ventures and similar structures are discussed in relation to federal fraud-and-abuse concerns.
- The role of managed care arrangements in the article’s discussion of payment and service-reduction risk.
- The federal organizations and statutes referenced in the compliance context.
Who Should Read This
- Hospital compliance officers
- Physician practices
- Health care attorneys
- Revenue cycle professionals
- Managed care administrators
- Medical coding and reimbursement professionals
Codes Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com