Credentialing & Privileging

Further discussion of the OIG and economic credentialing

Credentialing Resource Center Insider, February 14, 2003

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Dear Credentialing Colleague: The January 13 edition of Credentialing Connection, which discussed the Office of Inspector General's (OIG) call for public comment regarding "economic credentialing," generated a significant number of follow-up phone calls and e-mails from readers. Most of these readers requested further information about this seemingly hot topic. Here is some background.

On December 9, 2002, in response to years of lobbying by the American Medical Association (AMA), the OIG published in the Federal Register a request for comments on whether economic credentialing (i.e., hospitals' consideration of economic factors in making medical staff appointment and privileging decisions) violates federal antitrust laws. The AMA has argued for years that when hospitals engage in economic credentialing activities, they may be charged with giving "remuneration" (in the form of valuable clinical privileges) in exchange for the "referrals" anticipated from the privileged physician.

If the AMA's argument is correct, then isn't it a potential violation of antitrust laws every time a hospital grants medical staff privileges? The concept of hospital privileges as "remuneration" is contrary to the language of antitrust laws and two decades of regulatory guidance.

If the OIG now decides to re-interpret the law and determines that medical staff privileges are indeed "remuneration," then credentialing will undoubtedly become subject to the same intensive regulatory oversight--complete with safe harbors, fraud alerts, and so forth--that hospital contracting now requires. The result for hospitals and their medical staffs could be a significant increase in the cost, burden, and complexity of credentialing and privileging.

This issue is carefully explored in a 55-page booklet titled "Hospital Privileges as Kickbacks? The Economic Credentialing Debate Commands Renewed Attention," by Robin Locke Nagele, Esq., partner with the Philadelphia law firm Post & Schell, PC. If you would like a free copy in either electronic or booklet format, please e-mail your name, job title, organization name, address, telephone number, and e-mail address to:
A copy will be sent to you right away.

That's all for this week.

All the best,

Hugh Greeley

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