Office of Inspector General backs plan to pay for emergency call

Health and Human Services says such arrangements still pose legal risks.

By Amy Lynn Sorrel, AMNews staff. Oct. 22/29, 2007.

A hospital's proposal to pay physicians for providing on-call emergency coverage does not run afoul of the federal anti-kickback statute, says an advisory opinion posted Sept. 27 by the Health and Human Services Dept.'s Office of Inspector General.

Experts said they believe the letter is the first of its kind. It offers some guidance on what the government views as an acceptable plan to address on-call shortages. But that does not mean it's a one-size-fits-all solution, they warned.

The OIG opinion acknowledged that hospitals increasingly are compensating physicians for emergency coverage. "We are mindful that legitimate reasons exist for such arrangements," the agency said. These include scarcity of available doctors in a particular area and compliance with the federal Emergency Medical Treatment and Active Labor Act.

Nevertheless, OIG Chief Counsel Lewis Morris noted that on-call reimbursement still carries considerable legal risks. For example, "physicians may demand compensation as a condition of doing business at a hospital," or the payments "could be misused to entice physicians" to join a medical staff or generate referrals. Both would be considered illegal, Morris noted.

In its letter giving the green light to an unnamed medical center's reimbursement program, the inspector general's office highlighted several components that factored into its decision.

First, the agency noted that the hospital's payments to doctors reflect fair market value for the actual services they provide and are tied to tangible physician responsibilities, rather than referrals. The reimbursement system considers the physician's specialty and the likelihood of any inpatient follow-up care, among other factors. It also requires doctors to provide a minimum amount of uncompensated care.