decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2006 OIG Advisory Opinions / Opinion 06-17 - Marketing Payment Plan Approved
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Article Overview
This premium article reviews an OIG advisory opinion from 2006 concerning a dental preferred provider organization, its marketing company, and a federal employee health plan arrangement that may involve Medicare beneficiaries. It explains the general compliance and anti-kickback concerns raised by payments tied to patient access and why the OIG analyzed the arrangement as it did. The article is aimed at readers who need to understand fraud-and-abuse oversight, managed care marketing arrangements, and how federal health plan relationships may intersect with Medicare.
Why This Topic Matters
Health care organizations, marketers, and compliance professionals need to understand when arrangements involving patient access and referral-related compensation may raise anti-kickback concerns. This opinion summary highlights the type of factors regulators consider in evaluating marketing and network participation relationships.
What You Will Learn
- The compliance issues raised by marketing-related payments in a dental PPO arrangement
- How OIG advisory opinions address potential Anti-Kickback Statute concerns
- The relationship between a federal employee health plan arrangement and possible Medicare involvement
- General factors considered in evaluating whether an arrangement may warrant sanctions
Who Should Read This
- Medical coders
- Compliance officers
- Health care attorneys
- Practice managers
- Revenue cycle professionals
- Healthcare administrators
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