HHS-OIG Declines Sanctions on Medicare Supplemental Insurance Incentives for Use of Network Hospitals
Highlights
HHS-OIG released a favorable opinion on a Medicare Supplemental Insurance Plan’s desire to incentivize patients’ use of network hospitals by offering discounted inpatient deductibles and premium credits
The agency noted that incentives related to inpatient deductibles present a lower risk of overutilization since patients generally do not control whether they are admitted as an inpatient
The agency determined little risk for fraud and abuse as overutilization or increased costs to federal health programs are unlikely
On Dec. 18, 2023, the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) released Advisory Opinion No. 23-09, a favorable opinion regarding a proposed arrangement by which a Medicare Supplemental Health Insurance Plan (Medigap) would incentivize its policyholders to use specific hospitals within a preferred hospital organization (PHO) for inpatient care. Despite implicating both the federal Anti-Kickback Statute (AKS) and the beneficiary inducement civil monetary penalty (CMP) rules, the agency determined it would not impose sanctions.
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