With health care becoming more consumer-driven, health care providers and health plans are wrestling with how to incentivize patients to participate in health promotion programs and treatment plans. As payments are increasingly being tied to quality outcomes, a provider’s ability to engage and improve patients’ access to care may both improve patient outcomes and increase providers’ payments. In December 2016, the Office of Inspector General of the US Department of Health and Human Services (OIG) issued a final regulation implementing new “safe harbors” for certain patient incentive arrangements and programs, and released its first Advisory Opinion (AO) under the new regulation in March 2017. Together, the new regulation and AO provide guardrails for how patient engagement and access incentives can be structured to avoid penalties under the federal civil monetary penalty statute (CMP) and the anti-kickback statute (AKS).
New OIG Rules Change Patient Incentive Program Landscape: Where Are the Limits Now?
Posted In Anti-Kickback Statute / Stark Law
Tags: ACA, access to care, Advisory Opinion, Affordable Care Act, AKS, Anti-Kickback Statute, AO, AO 17-01, cash equivalents, CMP, federal civil monetary penalty statute, incentivize, low risk of harm, Medicaid, Medicare, Office of Inspector General of the US Department of Health and Human Services, OIG, patient-physician communication, remuneration, state health care
Emily J. CookEmily J. Cook provides counsel to health care providers on complex regulatory and reimbursement matters. Her regulatory experience includes fee-for-service Medicare and Medicaid reimbursement, billing and coding, licensure, survey/certification and accreditation, and compliance with Medicare and state fraud and abuse requirements. She also has significant experience counseling health care providers and other stakeholder entities on issues related to 340B drug pricing program implementation, compliance and advocacy. Read Emily J. Cook's full bio.
Tony MaidaTony Maida counsels health care and life sciences clients on government investigations, regulatory compliance and compliance program development. Having served as a government official, Tony has extensive experience in health care fraud and abuse and compliance issues, including the federal and state Anti-Kickback and Stark Laws and Medicare and Medicaid coverage and payment rules. He represents clients in False Claims Act (FCA) qui tam matters, government audits, civil monetary penalty and exclusion investigations, and Centers for Medicare and Medicaid Services (CMS) suspension, and revocation actions, negotiating and implementing corporate integrity agreements, and making government self-disclosures. Read Tony Maida's full bio.
Tiffany T. MasonTiffany T. Mason maintains a broad health law practice, advising hospitals, health systems and health industry clients on regulatory compliance and transactional matters. Read Tiffany T. Mason's full bio.
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