ED Coding & Reimbursement Alert - 2005 Issue 10
COMPLIANCE: Don't Take OIG Opinions as License to Go Nuts With Gainsharing
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Article Overview
This compliance-focused article discusses how recent HHS Office of Inspector General advisory opinions address gainsharing arrangements between hospitals and physicians. It explains why those opinions should be read narrowly, what kinds of safeguards were relevant, and why the topic remains important for hospitals, physician groups, compliance teams, and counsel evaluating incentive-based programs. The article also touches on related concerns such as malpractice exposure, patient risk, Medicare policy pressures, and the possibility of future legislative changes.
Why This Topic Matters
Hospitals and physicians considering shared-savings or efficiency incentive programs need to understand the limited scope of OIG advisory opinions and the continuing compliance risks around gainsharing. The article helps readers assess whether an arrangement may raise regulatory, patient-safety, or liability concerns without treating isolated opinions as broad approval.
What You Will Learn
- How recent OIG advisory opinions fit into the agency’s broader stance on gainsharing
- Why narrow safeguards and fact-specific review matter in compliance analysis
- What other risks may arise when incentive programs are linked to efficiency or cost reduction
- How gainsharing discussions intersect with patient safety, malpractice, and Medicare policy concerns
- Why future legislative action could affect the compliance landscape for hospital-physician arrangements
Who Should Read This
- Hospital compliance professionals
- Physicians and physician group leaders
- Health care attorneys
- Revenue cycle and reimbursement advisors
- Risk management and malpractice professionals
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