Per Diem Call Coverage and the Anti-Kickback Statute: What is Compliant?

Hospitals that pay per diem fees, or flat rates, to specialist physicians for emergency department call coverage have been viewed as teetering the line of the federal Anti-Kickback Statute, but an opinion from HHS' Office of Inspector General (pdf) ruled those per diem payments may be OK.

The OIG released the opinion, which involved an unnamed non-profit hospital. The hospital paid a per diem fee to specialists, such as cardiologists and neurosurgeons, who provided unrestricted call coverage in its ED. These one-year contracts require that physicians be available and respond to the hospital's required response times, and they must provide appropriate care and follow-up coverage to those who are admitted.

Per diem fees have been viewed as murky in the healthcare environment due to the Anti-Kickback Statute, which says any provider cannot offer, pay, solicit or receive any compensation to induce or reward referrals of services that Medicare or Medicaid reimburse. Per diem coverage could violate the Anti-Kickback Statute if payments exceed fair market value or if payments are made to physicians for on-call coverage not actually provided.

Hospitals have increased the usage of per diem fees for on-call coverage because "it may be difficult for hospitals to sustain necessary on-call physician services without providing" competitive compensation, according to the opinion.

However, per diem fees to physicians are legitimate if hospitals take the following steps:

•    Ensure that per diem payments are fair market value, based on independent valuation.

•    Allocate funds for call coverage for each physician specialty and calculate the per diem fees annually, which will lower the risk of hospitals rewarding high-volume referrers.

•    Ensure the fees are going toward actual and necessary services. Physicians must respond within 30 minutes of calls and provide follow-up care, in some instances.

•    Offer per diem fees to all specialists on the medical staff who may have to take unrestricted calls.

•    Structure compensation agreements so the hospital absorbs all costs, with no risk to federal healthcare programs.

More Articles on Per Diem Call Coverage:

28 Statistics on Highest Emergency On-Call Coverage Per Diem Payments

Call Coverage Payments: Trends, Regulations, Statistics and Valuation Considerations

Part-Time Physician Pay: 5 Points to Know

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