CHA News Article

Recent OIG Advisory Opinions Offer Insight on Hospital-Physician Arrangements

With the transformation of health care, integrated delivery systems are rapidly developing to align and coordinate care. Using co-management agreements is one way for hospitals and physician group practices to integrate overall care management. The U.S. Office of Inspector General recently issued an advisory opinion (No. 12-22, attached below) that evaluated a co-management arrangement between a rural hospital and a medical group, and included financial incentives for meeting certain performance and quality components. The opinion also offers strategic guidance on building in appropriate safeguards and avoiding some of the pitfalls when structuring hospital-physician arrangements that comply with federal laws designed to protect the integrity of federal health care programs, including the Anti-Kickback, Civil Monetary Penalty, and Stark law prohibitions, and the private inurement and private benefit restrictions that apply to tax-exempt hospitals. 

At a recent national health care law seminar, Deputy Inspector General Robert DeConti highlighted four particularly important advisory opinions issued in the last year:

  • Advisory Opinion 12-06 – reciprocal waivers of cost-sharing obligations for ambulance services
  • Advisory Opinion 12-15 – hospital per diem payments to physicians for providing ED on-call coverage
  • Advisory Opinion 12-20 – a hospital’s proposal to provide free access to an electronic interface to community physicians and physician groups for care coordination
  • Advisory Opinion 12-22 – a co-management arrangement between a hospital and a cardiology medical group that includes a performance-based bonus for patient service, quality, and cost-saving measures at the hospital’s cardiac catheterization laboratories 

Additional advisory opinions are available on the OIG website at https://oig.hhs.gov/compliance/advisory-opinions/index.asp.

 

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