HHS-OIG Issues Unfavorable Opinion Regarding Medicare Advantage, Gainshare Payments to Employers
Highlights
The HHS-OIG said it is essential to prevent financial incentives from steering enrollees toward specific Medicare Advantage plans or services in order to avoid undue influence on enrollment decisions
Gainshare payments also must safeguard enrollee benefits, ensuring that financial incentives do not reduce coverage or increase costs
CMS’ flexibilities for Employer Group Waiver Plans do not exempt organizations from compliance with the federal Anti-Kickback Statute
The Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG) has issued Advisory Opinion No. 24-08 regarding a corporation that offers Medicare Advantage (MA) plans proposing to share a percentage of its savings (gainshare payments) with certain employers to which it provides coverage through Employer Group Waiver Plans (EGWPs).
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