tci Medicare Compliance & Reimbursement - 2005 Issue 12

Compliance: Opinions Don't Mean Gainsharing's Got The Go-Ahead

OIG says gainsharing still a compliance concern.The HHS Office of Inspector General has now issued three more opinions approving gainsharing arrangements between hospitals and physicians - but that doesn't mean gainsharing is suddenly OK in the OIG's book.The OIG had listed gainsharing as a major source of compliance concern in its hospital compliance guidance, issued last year. Gainsharing refers to deals in which a hospital offers a physician group payments for improving efficiency or cutting costs. The OIG has been skeptical of arrangements that reward physicians for skimping on care, and also involve payments from referral sources...

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