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DOJ won't challenge hospital 'gainsharing' proposal

January 16, 2013

The Department of Justice's Antitrust Division does not intend to challenge a Greater New York Hospital Association proposal to offer a "gainsharing" program to member hospitals, the department said today after reviewing the proposal at the association's request. DOJ said that under the program, physicians could receive a share of the savings generated from reducing costs for treating commercial health insurance and Medicaid and Medicare managed care patients if the physicians meet hospital-specific quality standards. The department said that the proposed program, which is structured to comply with relevant fraud and abuse laws as well as antitrust laws and includes extensive program integrity controls, should not adversely affect competition because hospitals will not exchange any confidential information and each hospital will independently determine physician gainsharing amounts. Organizations may submit proposed actions to the Antitrust Division for review and receive a statement as to whether the division intends to challenge the described action under the antitrust laws.