Compensation for on-call coverage is becoming increasingly more common between hospitals and physicians. If such compensation arrangements are not done correctly, then they could be in violation of the federal anti-kickback statute (AKS).

Currently, the Office of Inspector General (OIG) has issued two call coverage advisory opinions, Advisory Opinion No. 07-10 (9/20/2007) and Advisory Opinion 09-05 (5/14/2009), where the OIG found that such arrangements did not violate AKS. Each advisory opinion approved a different type of call compensation structure, per diem and per service payment for uninsured patients. According to the OIG, some practices that can be gleaned from the facts include, but are not limited to, the following:

  1. Internal documentation should be created to show that there is a legitimate reason for call coverage compensation in the community. One way to do this is to create a community needs checklist that can be utilized by a nonprofit hospital to show that a need exists for call coverage by a certain specialty and that failure to compensate for call coverage will cause the community to not be able to receive emergency services in such a specialty.
  2. Internal documentation should be created to identify the compensation mechanism for call coverage. Currently, the most common methods for call coverage are per diem, per service, activation fee, pooling or a combination of any of the aforementioned methods. The internal documentation should also state why such a compensation method was chosen and, if applicable, whether such compensation will be for all patients or just indigent patients.
  3. Any and all coverage compensation between a hospital and a physician should be in writing and should set forth legitimate and quantifiable services that a physician is performing in return for receiving compensation.
  4. Compensation for call coverage is fair market value. It is a good idea to get an independent valuation company to review the coverage arrangement and to issue a valuation report that contains a fair market value range for call coverage compensation for that specific situation.
  5. A hospital should have written documentation that call coverage has actually been provided by a physician. This can be done through a physician log developed by the hospital that reflects when and what call coverage has been provided by a physician.