The proposed arrangement at issue would allow a licensed offeror of health insurance and Medigap plans to indirectly contract with network hospitals for discounts on inpatient hospital deductibles covered by the Medigap plans. The discounts could be up to 100 percent.
The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit or receive any remuneration or to induce or reward referrals of items or services that are reimbursable by a federal healthcare program. According to the OIG report, the premium credits that the insurer would offer to Medigap policyholders who have inpatient stays at network hospitals and the discounts that network hospitals would offer on inpatient deductibles pose a minimal risk of fraud and abuse.
The proposed arrangement involved a “straightforward agreement” between the network hospital and the insurer, and both the discounts and premium credits would not affect per-service Medicare payments. The proposed arrangement could lower Medigap costs for policyholders who select network hospitals without raising costs for those who use an out-of-network hospital, according to the report. The OIG noted that its advisory opinion is limited to the specific arrangement described and does not apply to other similar arrangements.
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