tci Medicare Compliance & Reimbursement - 2008 Issue 35
Compliance:OIG Gives OK To Outsourcing Pre-Authorizations
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Article Overview
This article explains an OIG advisory opinion addressing whether a proposed outsourcing arrangement for insurance preauthorizations could raise anti-kickback concerns. It is relevant to compliance professionals, managed care organizations, radiology and imaging centers, and other providers considering administrative outsourcing arrangements. The discussion focuses on the general framework of the opinion, the role of fair market value, and the compliance sensitivity around compensation methods.
Why This Topic Matters
The piece helps readers understand how the OIG evaluates administrative service arrangements in healthcare and why compensation design can affect compliance risk. It is useful for organizations that work with outside vendors on preauthorization or similar back-office functions and need to assess fraud-and-abuse exposure.
What You Will Learn
- How an OIG advisory opinion can apply to outsourced preauthorization services
- Why compensation structure is a compliance issue in administrative service arrangements
- What types of healthcare business relationships may prompt anti-kickback scrutiny
- How compliance considerations may differ for managed care, imaging, or home care contexts
Who Should Read This
- Healthcare compliance professionals
- Medical practice administrators
- Radiology and imaging center managers
- Managed care organizations
- Healthcare attorneys
- Revenue cycle and authorization staff
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