decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Model Compliance Plan / Common Fraud and Abuse Concerns / Routine Waiver of Deductibles and Coinsurance
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Article Overview
This article explains OIG compliance guidance addressing the routine waiver of patient cost-sharing in the Medicare context. It is relevant to providers, compliance staff, billing personnel, and practice administrators who need to understand fraud-and-abuse concerns, beneficiary inducements, and the kinds of written policies and procedures the guidance discusses. The article also references related federal authorities and compliance materials that frame the issue.
Why This Topic Matters
Routine waiver of cost-sharing can create compliance exposure for providers and organizations, especially when policies are informal or inconsistently applied. Understanding the OIG’s guidance helps practices reduce fraud-and-abuse risk and align internal procedures with federal expectations.
What You Will Learn
- The compliance and fraud-and-abuse risks associated with routine waivers of patient cost-sharing
- Why written policies and uniform financial-need criteria are discussed in the guidance
- The general types of organizational practices that raise concern in this area
- Which federal authorities and compliance materials are referenced in connection with the topic
Who Should Read This
- Healthcare providers
- Medical practice administrators
- Billing and compliance staff
- Revenue cycle personnel
- Healthcare attorneys and consultants
Codes Discussed
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