decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2001 OIG Advisory Opinions / Opinion 01-20 - Payment Arrangement For Dually Eligible Hospice Patients Barred
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Article Overview
This premium summary covers an Office of Inspector General advisory opinion from 2001 addressing a proposed hospice payment arrangement for patients eligible for both Medicare and Medicaid. It explains the compliance and fraud-and-abuse context, the OIG’s reference to prior guidance, and the factors that made the arrangement problematic. The article is relevant to hospice providers, nursing facilities, compliance staff, and healthcare counsel reviewing anti-kickback and related advisory opinion material.
Why This Topic Matters
It helps readers understand how OIG evaluates hospice-related financial arrangements involving dually eligible patients and why missing operational details can raise fraud-and-abuse concerns.
What You Will Learn
- The advisory opinion context for a hospice payment arrangement involving dually eligible patients.
- How the OIG frames fraud-and-abuse risk in hospice and nursing home financial relationships.
- Why supporting operational details can matter in evaluating proposed payment structures.
- How prior OIG fraud alert guidance is referenced in the opinion summary.
Who Should Read This
- Hospice administrators
- Nursing home administrators
- Compliance officers
- Healthcare attorneys
- Revenue integrity professionals
- Medical coders involved in compliance review
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