On May 21, 2009, the Department of Health and Human Services Office of Inspector General (OIG) released a new advisory opinion in which it decided not to impose administrative sanctions against a 400-bed acute care hospital that proposed to compensate physicians for on-call services performed on behalf of the hospital's uninsured patients. The hospital had determined that physicians commonly viewed on-call coverage as an unwanted obligation, jeopardizing the hospital's ability to serve patients. Consequently, the hospital proposed a new on-call coverage policy and program which would allow participating physicians to submit claims to the hospital for payment for services rendered to certain "eligible patients" presenting to the hospital's Emergency Department. "Eligible patients" included those patients that have no sponsoring insurance plan and must eventually qualify for a state program.
The OIG determined that the hospital's proposed on-call program presented "a low risk of fraud and abuse" because:
- The hospital certified that the payment amounts made to physicians were within the range of fair market value for services rendered, without regard to referrals or other business generated between the parties;
- The payments under the proposed program are tailored to cover substantial, quantifiable services, all of which will be furnished to uninsured patients that present to the hospital's Emergency Department;
- The circumstances giving rise to the proposed on-call program suggest that the hospital has legitimate rationales for revising its on-call coverage policy (i.e., hospital does not have needed specialists on-call for weeks, and dislike by medical staff of being on-call because of its disruptive nature, liability issues and lack of compensation);
- The program would be offered uniformly to all physicians (other than hospital-based physicians and non-active staff physicians) and impose tangible responsibilities on them (e.g., physicians must respond within 30 minutes);
- The method of scheduling on-call coverage would be governed by the hospital's medical staff bylaws, would be uniform within each department or specialty and would appear to be an equitable policy that would not be used to selectively reward the highest referrers; and
- The program is an equitable mechanism for the hospital to compensate physicians who actually provide care that the hospital must furnish to be eligible for state funding. Thus, the program would promote an obvious public benefit in facilitating better emergency on-call and related uncompensated care physician services at the hospital.
This new OIG Advisory Opinion No. 09-05 can be found here.