One of the most difficult problems to be addressed by medical practitioners is the crisis presented by the repeated reduction in fee schedules for Medicare services. As physicians continue to see dramatic reductions in reimbursements, increased demands on their time, hospital cost initiatives and growth in patient and procedure volumes, they are continuously looking for sustainable ancillary revenue sources. This has led many physicians to develop arrangements with fellow practitioners designed to pool resources and share overhead. Often termed “Joint Venture” arrangements, the OIG has identified a number of characteristics of suspicious Joint Ventures which the OIG termed “common elements,” which will raise “red flags” and trigger enforcement actions.

It is no longer sufficient to attempt to comply with “Safe Harbor” rules, without also considering letter opinions, Fact Sheets, Special Fraud Alerts and Bulletins designed to identify patterns of behavior which will trigger enforcement action. The OIG has published in the Code of Federal regulations, a number of “factors” it considers consistent with illegal joint venture agreements.

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