decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2001 OIG Advisory Opinions / Opinion 01-15 - MCO May Cover Co-Payments For Needy Patients
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Article Overview
This article summarizes a 2001 Office of Inspector General advisory opinion addressing a managed care organization’s proposal related to financial assistance for beneficiaries enrolled in a Medicare+Choice product. It explains the compliance context, the OIG’s discussion of need-based payment relief, and the concerns the agency noted about potential influence on beneficiary provider choice. The piece is relevant to compliance professionals, managed care organizations, legal teams, and healthcare administrators reviewing anti-kickback and beneficiary assistance issues.
Why This Topic Matters
It helps readers understand how the OIG viewed a proposed arrangement involving premium and co-payment assistance, and why these issues matter for fraud-and-abuse compliance in managed care settings.
What You Will Learn
- The compliance context for an OIG advisory opinion involving beneficiary premium and co-payment assistance.
- How the article frames financial need determinations in a managed care setting.
- What general concerns the OIG noted about potential influence on future provider choice.
- The significance of the opinion for anti-kickback and beneficiary assistance compliance review.
Who Should Read This
- Compliance officers
- Healthcare attorneys
- Managed care organizations
- Medical group administrators
- Revenue integrity professionals
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