Medicare insurer can use discounts to encourage use of select hospitals, OIG says

Listen
Text
  • Small
  • Medium
  • Large

A health insurer that provides supplemental Medicare insurance and a preferred hospital organization can incentivize members to seek care at hospitals in the organization's network, according to an advisory opinion from the HHS Office of Inspector General. 

The opinion, released July 19, involves an unnamed medigap plan and an unnamed hospital organization. The medigap plan covers Medicare Part A deductibles that may be incurred during a hospital stay. 

Under their arrangement, the insurer and hospital organization agree that each network hospital can provide a discount on the Medicare Part A inpatient deductible that the supplemental plan would otherwise cover for the member, according to the inspector general. Members could also get a $100 premium credit for using network hospitals.

In its advisory opinion, the inspector general determined that "the proposed arrangement poses a sufficiently low risk of fraud and abuse under the federal anti-kickback statute, and we would not impose administrative sanctions."

The advisory opinion only applies to this specific arrangement, the inspector general said.

Copyright © 2021 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Whitepapers

Featured Webinars