Post-MACRA Gainsharing OIG Advisory Opinion Focuses on Patient-Centered Care

Compliance Today June 2018

Diana M. Fratto, Paulina Grabczak, and Gary W. Herschman, in the Health Care and Life Sciences practice, in the firm’s Newark office, authored an article in Compliance Today, titled “Post-MACRA Gainsharing OIG Advisory Opinion Focuses on Patient-Centered Care.”

Following is an excerpt (see below to download the full version in PDF format):

On January 5, 2018, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG) released its first guidance on gainsharing in five years, Advisory Opinion 17-09, in which it approved a gainsharing arrangement between neurosurgeons and a medical center concerning spinal fusion surgeries. ...

Prior to MACRA, the Gainsharing CMP prohibited hospitals from knowingly making a payment, directly or indirectly, to a physician as an inducement to reduce or limit services provided to federal program patients. However, following MACRA, the Gainsharing CMP now only prohibits reductions or limitations in medically necessary services. “Medically necessary” is not defined in MACRA, and it was unclear how the amendment impacted the structuring of gainsharing arrangements. ...

OIG’s latest Advisory Opinion provides helpful guidance as to how OIG views gainsharing arrangements following MACRA’s amendment, and sheds light on important safeguards to include against reducing or limiting medically necessary services. Further, Advisory Opinion 17-09 reinforces much of OIG’s prior guidance on gainsharing arrangements and safeguards to protect against violations of the Gainsharing CMP and AKS.