tci Medicare Compliance & Reimbursement - 2003 Issue 20

Kickbacks: DEDUCTIBLE DEALS LEGAL BETWEEN HOSPITALS, MEDIGAP PLANS

Medigap insurers may be able to work deals with hospitals for cut rates on inpatient deductibles. That's the upshot of the HHS Office of Inspector General's most recent advisory opinion (No. 03-10). In the opinion, the OIG takes the measure of an insurer's proposal to contract with preferred provider organizations for inclusion of its policyholders in the PPOs' hospital networks. The insurer would get a discount of up to 100 percent on Medicare inpatient deductibles it would otherwise have to pay under its Medigap policies. Under the plan, the insurer also would reward policyholders who used network hospitals with...

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