A new advisory opinion from HHS’ inspector general’s office concludes that a hospital’s plan to compensate physicians for on-call coverage for its emergency department is unlikely to be a conduit for kickbacks.
The unnamed hospital that requested the opinion is described as a 400-bed facility that is the only acute-care provider in the county and is having trouble getting physicians to commit to on-call coverage, with “weeks each month when the hospital does not have needed specialists on call.” The proposed arrangement would pay doctors fixed sums—$100 for consultations, $350 for a surgical procedure, and so forth—when their on-call duties require them to treat uninsured patients.
The letter signed by Lewis Morris, chief counsel to the inspector general,
acknowledges that hospitals are increasingly and legitimately resorting to paying physicians for on-call coverage. “There is a substantial risk that improperly structured payments for on-call coverage could be used to disguise unlawful remuneration,” the letter states, offering as examples amorphous payment structures that compensate “lost opportunity” when there’s no actual loss of income and payments for services for which the physician then bills another payer.
Under the arrangement discussed, however, the hospital would make only fair-market payments for specific services provided to patients with no insurance. The hospital also made a case for having a legitimate need to compensate physicians in order to round out coverage, which the letter concludes would “promote an obvious public benefit” by improving indigent care at the county’s only acute-care hospital.
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