decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 1998 OIG Advisory Opinions / Opinion 98-05 - Nursing Home Benefits Waiver Could be Kickback
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Article Overview
This article summarizes an OIG advisory opinion from 1998 involving a nursing home, a health plan, and Medicare managed care coordination of benefits. It explains why the arrangement raised compliance concerns under the Anti-Kickback Statute and why routine patient cost-sharing waivers matter to providers, plans, and compliance professionals.
Why This Topic Matters
It helps readers understand how OIG views financial arrangements that may influence referrals and the handling of Medicare patient cost-sharing, which is important for compliance review and contract design.
What You Will Learn
- The compliance issues raised by a nursing home and HMO arrangement
- How OIG framed anti-kickback concerns in the context of Medicare managed care
- Why patient cost-sharing waiver practices can attract regulatory scrutiny
- The relationship between coordination of benefits arrangements and fraud and abuse concerns
Who Should Read This
- Health care compliance professionals
- Medical coders and billing staff
- Nursing home administrators
- Health plan and managed care contract managers
- Health care attorneys
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