decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Civil Money Penalties / Offenses / Beneficiary inducements
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Article Overview
This premium article explains a Medicare and Medicaid compliance issue involving prohibited remuneration offered to beneficiaries, the associated civil money penalties, and a limited preventive-care exception. It is relevant to compliance staff, coders working with healthcare regulatory references, auditors, and providers that need a high-level understanding of federal penalty exposure and related OIG enforcement context.
Why This Topic Matters
The topic affects provider compliance programs and helps readers recognize when beneficiary-related incentives may trigger civil money penalties or exclusion concerns under federal regulations.
What You Will Learn
- The general prohibition on offering remuneration to Medicare or Medicaid beneficiaries to influence service use
- How civil money penalty exposure is described for violations in different time periods
- That exclusion may also be a potential consequence in connection with the offense
- The existence of a preventive-care-related exception and the broad categories it covers
- That the article addresses federal regulatory references and OIG-related enforcement context
Who Should Read This
- Healthcare compliance professionals
- Medical coders
- Auditors
- Billing and reimbursement staff
- Providers and supplier organizations
Codes Discussed
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