OIG: Paying physicians more to boost screenings doesn't violate kickback laws

An insurer's plan to provide incentive payments to physicians in its network to boost preventive health screenings to Medicaid beneficiaries would not violate the federal Anti-Kickback Statute, according to an advisory opinion from HHS' Office of Inspector General.

Under the proposed arrangement, the Medicaid managed care plan would pay network providers $1 per existing enrollee for increasing early and periodic screening, diagnostic, and treatment services by at least 10 percent year over year. Providers with a 20 percent increase in those services would receive a $2 boost per enrollee, and those with a 30 percent increase would receive $3 per enrollee.

The proposed arrangement would not provide an incentive to providers to recruit new Medicaid beneficiaries because the incentive payment would be based only on the percentage change in the volume of EPSDT services provided to existing enrollees. The insurer also noted that it would not shift the increased costs related to the increase in EPSDT services or the costs of the incentive to the Medicaid program.

"Based on the facts certified in your request for an advisory opinion and supplemental submissions, we conclude that the Proposed Arrangement would not generate prohibited remuneration under the anti-kickback statute," the OIG said in the advisory opinion.

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