decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Inpatient Hospital Services / Gainsharing arrangements
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Article Overview
This premium article explains the federal compliance landscape surrounding inpatient hospital gainsharing arrangements, including the historical OIG position, later advisory opinion developments, and the legal framework that shaped the agency’s treatment of these arrangements. It is intended for readers who need a high-level understanding of the policy and regulatory context, including hospital compliance staff, physicians, auditors, and coding/reimbursement professionals working with inpatient hospital services. The discussion covers the special advisory bulletin, related advisory opinions, and the broader issues of fair market value, quality of care, and federal sanctions.
Why This Topic Matters
Gainsharing arrangements can create significant fraud-and-abuse and reimbursement compliance risk for hospitals and physicians. Understanding the governing guidance helps organizations evaluate arrangement structure, documentation, and regulatory exposure.
Article Sections
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Gainsharing arrangements and regulatory context
Introduces the concept of hospital-physician gainsharing and the general compliance issues associated with these arrangements. Describes the broader policy setting and references related guidance topics.
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OIG guidance and advisory opinion developments
Summarizes the historical OIG position, the special advisory bulletin, and the later advisory opinion landscape discussed in the article. Covers the general scope of agency guidance without detailing specific outcomes.
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Legal framework and special advisory bulletin
Reviews the statutory and enforcement framework referenced in the article, including the federal law background and potential sanctions. Notes the timing of the bulletin relative to later advisory opinions.
What You Will Learn
- The compliance issues associated with hospital gainsharing arrangements
- How OIG guidance has addressed gainsharing over time
- The legal and regulatory framework referenced by the article
- Why fair market value and quality-of-care considerations are relevant to these arrangements
Who Should Read This
- Hospital compliance teams
- Physicians and physician group leaders
- Health care auditors
- Revenue cycle and reimbursement professionals
- Fraud and abuse compliance professionals
Codes Discussed
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