The Office of Inspector General of the Department of Health and Human Services has issued Advisory Opinion No. 09-05, which states that the OIG will not impose sanctions regarding a proposed on call arrangement in which the hospital will compensate physicians for providing on call coverage for patients presenting to the hospital or emergency department. The hospital will have a formal on call policy and program only available to active members of the medical staff of the hospital who specifically agreed to participate in accordance with the terms and conditions of the policy, and who will receive a flat fee that varies for consults, admissions, and certain surgical and other procedures.
The Advisory Opinion recognizes the potential for abuse for paying physicians to provide on call coverage at hospitals to which they admit patients, but also recognizes the difficulties all hospitals have had securing appropriate call coverage in a changing environment in which physicians no longer voluntarily assume the burden of providing on call coverage.
In addition to citing the presence of the factors objectifying approval, i.e. participation in a formal call coverage based upon a written agreement providing fixed fees for certain services which fees were determined to represent fair market value, the OIG has also identified circumstances in which it would have had enforcement questions, i.e.:
1. Compensation for lost opportunity or similarly designed payments that do not reflect bona fide lost income;
2. Payment structures that compensate physicians when no identifiable services are provided;
3. Aggregate on call payments that are disproportionately high compared to the physician’s regular medical practice income; or
4. Payment structures that compensate the on call physician for professional services for which he or she receives separate reimbursement from insurers or patients, resulting in the physician essentially being paid twice for the same service.