decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2006 OIG Advisory Opinions / Opinion 06-15 - Managed Care Company May Pay Doctors on Behalf of Medicaid
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Article Overview
This advisory opinion summary explains how the Office of Inspector General evaluated a managed care company’s role in administering a state Medicaid disease management pay-for-performance program. It is relevant to compliance, fraud-and-abuse review, managed care operations, and Medicaid program administration because it discusses the structure of the arrangement, the parties involved, and the safeguards used to address potential kickback concerns. The article is a high-level summary of the opinion and its rationale rather than a coding or billing guide.
Why This Topic Matters
Healthcare compliance professionals and managed care organizations may use this summary to understand how OIG viewed a state-funded incentive arrangement involving doctors and Medicaid patients. It highlights the kinds of oversight, funding flow, and documentation practices that can matter in fraud-and-abuse analysis.
What You Will Learn
- The general structure of a Medicaid-linked disease management incentive arrangement
- How an OIG advisory opinion summary frames anti-kickback risk considerations
- What broad safeguards were described in connection with payment administration and documentation
- Why managed care contractors and compliance teams may review advisory opinions like this one
Who Should Read This
- Compliance officers
- Managed care organizations
- Healthcare attorneys
- Fraud and abuse analysts
- Medicaid administrators
- Physician practice managers
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