decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 1999 OIG Advisory Opinions / Opinion 99-07 - Coinsurance Waiver Approved For Non-Profit's Ophthalmologist
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Article Overview
This premium article covers an OIG advisory opinion from 1999 involving a nonprofit vision-care program and whether its across-the-board waiver of beneficiary cost-sharing can be approved under federal fraud-and-abuse rules. It is relevant to compliance, reimbursement, and healthcare legal audiences interested in beneficiary inducement, OIG advisory opinions, and nonprofit patient-assistance arrangements. The discussion focuses on the program structure, the regulatory concerns reviewed by OIG, and the factors supporting the opinion.
Why This Topic Matters
Organizations that offer discounts, waivers, or patient assistance need to understand how those policies intersect with federal beneficiary inducement and anti-kickback concerns. This article helps readers assess compliance risk for nonprofit service programs and similar arrangements.
What You Will Learn
- How an OIG advisory opinion frames a nonprofit program’s beneficiary cost-sharing waiver
- What compliance concerns arise when cost-sharing is waived for covered services
- Why nonprofit patient-assistance arrangements are reviewed under federal fraud-and-abuse rules
- How an advisory opinion can address provider participation in a charitable care program
Who Should Read This
- Healthcare compliance professionals
- Medical coders
- Revenue cycle staff
- Healthcare attorneys
- Physician practice managers
- Nonprofit healthcare administrators
Codes Discussed
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