OIG Advisory Opinion Includes Neurology in On-Call Reimbursement

February 28, 2013

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 The Health and Human Services’ Office of Inspector General (OIG) published an advisory opinion addressing whether the anti-kickback statute may be triggered when a hospital pays a per diem fee to physicians for providing on-call hospital emergency department coverage. The OIG concluded that the arrangement in question presented a low risk of fraud and abuse and would not give rise to administrative sanctions due to a variety of factors outlined in the summary. The OIG also outlined compensation structures to avoid when developing an on-call coverage arrangement.

The on call arrangement was developed in response to shortages experienced by the hospital in neurology and neurosurgery specialties. The OIG confirmed that neurology is included in the on call arrangement.

The OIG determined that the on call arrangement does not violate the anti-kickback statute for the following reasons:

  • the per diem is within the range of fair market value
  • the hospital allocates funds for call coverage for each participating specialty and calculates the per diem annually, in advance
  • physicians provide reasonable and actual services for which they are not compensated
  • the arrangement is available to all specialists who are staffed and required to take unrestricted call
  • the arrangement is structured so that the hospital takes in all costs and none accrue to  Federal Health programs

It is important to note that compensation within the on call arrangement varies by specialty and is based on three factors:

  • the number of days and months the specialty will be called
  • the number of patients the on-call physician will see on a daily basis
  •  the number of patients needing inpatient care and post-discharge follow up care in an office with the on-call physician

The AAN supports the OIG’s advisory opinion and has long believed that patients and communities will have better access to emergency neurologist services for stroke and other illnesses when neurologists are reimbursed to be on call.