decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 1998 OIG Advisory Opinions / Opinion 98-08 - Higher Charges to Medicare Okay if Tied to Compliance Costs
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Article Overview
This article summarizes a 1998 Office of Inspector General advisory opinion involving a durable medical equipment supplier and pricing differences between Medicare and non-Medicare customers. It explains the general compliance issue addressed by the opinion, the type of cost-justification analysis considered, and why the request was not fully resolved on the facts provided. The piece is most relevant to readers tracking anti-kickback guidance, Medicare compliance, and DME billing policy.
Why This Topic Matters
It helps readers understand how OIG evaluated pricing differences connected to Medicare compliance costs and why documentation of costs and margins mattered in the opinion.
What You Will Learn
- How a Medicare pricing question was analyzed in an OIG advisory opinion context
- Why compliance-related cost justification was central to the discussion
- What kinds of provider fact patterns may raise anti-kickback advisory opinion questions
- How this opinion fits into broader durable medical equipment compliance concerns
Who Should Read This
- Medical coders
- Compliance officers
- DME suppliers
- Healthcare attorneys
- Revenue cycle professionals
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