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OIG fraud alert targets physician compensation agreements

Agency says physician payments must reflect fair market value

A new fraud alert released by the Office of the Inspector General (OIG) highlights the agency's renewed interest in physician compensation arrangements that could violate anti-kickback regulations if payments do not reflect fair market value.

The OIG specifically cites issues tied to medical directorships that pay for services a physician did not actually provide. In addition to payments that go above fair market value, compensation arrangements that account for the volume or value of referrals could be considered anti-kickback violations.

Subsidizing office costs can also be considered a kickback, since it reduces the financial burden for physicians, according to the OIG.

The report highlights recent settlements with 12 individual physicians who fell into one of these improper payment categories. In some of those cases, physicians entered into agreements in which front office staff salaries were paid by an affiliated healthcare entity.

The recent fraud alert shows the OIG's intent to direct investigative resources towards individual physicians under its Civil Monetary Penalties Law (CMPL), Tony Maida, a partner at McDermott Will & Emory LLP, wrote in a recent blog post. With a larger budget and more attorneys, it's likely that physicians will face more scrutiny regarding payments and referrals.

"The OIG has displayed additional signs of interest in physicians, including a ramped-up issuance of guidance," he wrote. "After a somewhat lengthy span without issuing much guidance, the OIG has issued a new fraud alert specifically addressing physician issues each year for the past three years."  

In last year's fraud alert, the OIG targeted lab payments to physicians that exceed fair market value. Reports released earlier this year predicted that False Claims Act cases and anti-kickback regulations would remain a priority in 2015, leading some to emphasize the necessity of airtight corporate compliance plans.

For more:
- here's the OIG's fraud alert
- read the McDermott Will & Emory post

Related Articles:
Lab services, pay arrangements draw OIG's eye
OIG: Fight fraud to increase savings
Physician pay mostly flat in 2014