The Department of Health and Human Services Office of the Inspector General issued an advisory opinion on hospital emergency room on-call coverage that determined a flat-fee payment schedule presented a low fraud and abuse risk.
The 12-page opinion was issued to the unnamed 400-bed hospital, the sole provider of inpatient acute care services in its unidentified county. The hospital currently has no arrangement to compensate on-call physicians for treating uninsured patients presenting with emergencies, some of whom present medical malpractice liabilities. Increasingly the hospital is finding shortages of specialists for on-call duty.
According to the letter, the hospital set up a proposed compensation arrangement that would allow physicians treating financially eligible uninsured patients to submit claims to the hospital’s patient financial services department and would compensate physicians based upon a flat-fee payment plan.
The OIG determined in its legal analysis that the proposed compensation arrangement presents “a low risk of fraud and abuse.”
The advisory opinion, which only applies to the proposed arrangement by this hospital, is viewed as guidance for others in the industry wrestling with the same issues.
On-call coverage continues to be a hot-button issue between physicians and hospitals as specialists increasingly are refusing to provide coverage in an era of growing numbers of uninsured patients. At the same time, hospitals are obligated by the federal EMTALA law to provide those services.
To read the OIG’s advisory opinion on physician on-call coverage, visit www.oig.hhs.gov/fraud/docs/advisoryopinions/2009/AdvOpn09-05.pdf.