decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2001 OIG Advisory Opinions / Opinion 01-13 - Coinsurance Waiver Deal Approved Between HMO and Nursing Homes
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Article Overview
This short advisory-opinion summary reviews an Office of Inspector General discussion involving a health maintenance organization, nursing homes, and a coinsurance-waiver or coordination-of-benefits arrangement. It is relevant to compliance, fraud-and-abuse, and healthcare reimbursement audiences who need a high-level understanding of the factors the agency considered when evaluating the arrangement.
Why This Topic Matters
The summary helps readers understand how the OIG assessed risk in a healthcare payment arrangement involving Medicare-related cost sharing and provider incentives. It is useful for compliance professionals and healthcare organizations reviewing similar operational structures.
What You Will Learn
- The general compliance issues raised by a coordination-of-benefits arrangement between a health plan and nursing homes.
- The types of contextual factors the OIG considered in evaluating fraud-and-abuse risk.
- How Medicare-related cost-sharing and payment structure can affect advisory opinion analysis at a high level.
- The role of state insurance oversight in the arrangement discussed in the summary.
Who Should Read This
- Healthcare compliance professionals
- Hospitals and nursing facilities
- Health plan administrators
- Healthcare attorneys
- Revenue cycle and reimbursement staff
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