January 2018
The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) recently posted its first advisory opinion interpreting a gainsharing arrangement – that is, a financial relationship under which providers share in cost-savings – since passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The opinion, Advisory Opinion 17-09 (the “Opinion”), marks the OIG’s first interpretation of the Civil Monetary Penalties Law (CMP) since MACRA amended the law to limit the prohibition on gainsharing arrangements to those involving reductions or limits in medically necessary services, as opposed to all services, including medically unnecessary services.

The OIG concluded that it would not impose sanctions on the arrangement. The Opinion provides potentially valuable insight into how the OIG may address gainsharing arrangements going forward, which hospitals and providers may want to consider as many move into value-based and alternative payment arrangements, particularly arrangements including cost saving distributions.

To view the full e-alert, click here.