Waiving Copays Associated with Medicare - Just as Illegal Now as it Was in 1994

Why This Topic Matters

Understanding how cost-sharing waivers intersect with fraud and abuse law is important for organizations that bill Medicare or handle patient financial responsibility. The article highlights why this topic remains relevant for compliance programs, audits, and risk management.

Article Sections

1. Background and HHS-OIG Special Fraud Alert

   Introduces the historical HHS-OIG fraud alert context and the broader federal concern surrounding cost-sharing waivers. It also frames the issue within Medicare-related fraud and abuse oversight.

2. Deductibles and Copayments: General Compliance Issue

   Explains the topic at a general level and discusses the distinction between types of patient cost-sharing. The section focuses on why the subject is significant for Medicare billing and compliance.

3. Rationale for the Prohibition and Limited Exceptions

   Describes the federal concern with routine waivers and notes that limited hardship-related circumstances may be treated differently. It also addresses the compliance implications of failing to make a good-faith collection effort.

4. Recent Conviction

   Summarizes a recent enforcement action involving alleged cost-sharing waiver conduct and related healthcare fraud allegations. The section places the conduct in the context of potential criminal exposure and sentencing considerations.

5. False Claims Act Settlement Example

   Reviews a civil settlement involving allegations of waived copayments and false claims submissions. It shows how these issues can lead to government intervention and settlement activity.

6. Conclusion

   Wraps up the article with a compliance-oriented discussion of ongoing federal interest and the need for documentation and internal review. It also mentions a temporary policy context related to the COVID-19 public health emergency.