A gainsharing agreement between an academic medical center and orthopedic surgery and neurosurgery groups with active staff privileges at the center was ruled to be improper by the HHS inspector generals office, but the office will not impose any sanctions on the parties, which voluntarily sought the opinion on their arrangement.
The arrangement called for sharing the savings incurred by limiting the use of bone morphogenetic protein, a bone growth stimulant, and standardizing the use of 35 spine fusion devices and supply products where appropriate. While the arrangement was found to be transparent and based on credible medical support, the office concluded that the arrangement might have induced physicians to reduce or limit the then-current medical practice at the medical center. According to the opinion, current statutes call for civil monetary penalties against any hospital that knowingly makes a payment directly or indirectly to a physician as an inducement to reduce or limit items or services to Medicare or Medicaid beneficiaries under the physicians direct care.
In an e-mail, a representative from the HHS public affairs department said the opinion could be construed as the office giving the arrangement its approval. But he also cited passages in the opinion which stated that the agreement "constitutes an improper payment to induce reduction or limitation of services" and "potentially generates prohibited remuneration under the antikickback statute." The medical center and the surgical groups were not identified. -- by Andis Robeznieks