OIG Special Advisory Bulletins / OIG Special Advisory Bulletin 99-1_July 8, 1999 / Legal Analysis

Why This Topic Matters

Hospitals and physicians need to understand how federal fraud-and-abuse rules may apply to shared-savings and other incentive-based arrangements. The article highlights why these structures can raise compliance concerns and why the OIG views uniform standards as important.

Article Sections

1. Prohibition on hospital payments to physicians to induce reduction or limitation of services

   Introduces the core legal issue and the federal authority discussed in the bulletin. Summarizes the general scope of the prohibition and the penalty framework referenced by the OIG.

2. Legislative background and statutory history

   Reviews the background leading to the current legal interpretation, including earlier statutory language and related federal policy developments. Describes the legislative context relied upon by the OIG.

3. Gainsharing Arrangements

   Explains the general concept of gainsharing and the types of hospital-physician financial structures commonly associated with it. Also addresses the operational and care-management issues the bulletin discusses at a high level.

4. Application of SSA §1128A(b)(1) to gainsharing arrangements

   Covers the OIG’s application of its statutory analysis to gainsharing structures and similar incentive plans. Discusses the agency’s reasons for viewing these arrangements through the lens of fraud-and-abuse enforcement and oversight.

5. Application to other arrangements

   Addresses additional hospital-physician business structures and clinical ventures mentioned in the bulletin. Focuses on the broader compliance implications the OIG identifies for related arrangements.