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OIG Warns of Pre-Authorization Violations

Cheryl Clark, for HealthLeaders Media, September 2, 2010

2. The hospital would be no payments to physicians, nor would the use of the service imply the pre-authorization request getting approval.

3. Personnel would identify themselves to insurers as employees of the hospital, disclose to insurers the nature of the program, and would provide each doctor a copy of all information it submits to insurers to obtain pre-authorization for that doctor's patients. There would be "little opportunity to influence referrals because patients would have already selected Requestor."

4. The hospital has a legitimate interest in offering uniform pre-authorization services.

The office emphasized that the opinion is limited only to the particular hospital that asked for the opinion, which was keyed to providing pre-authorization approvals to cover diagnostic imaging services.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.

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