Vasilios J. Kalogredis of Lamb McErlane. Courtesy photo OIG Issues Unfavorable Opinion for Proposal to Share a Percentage of Savings
The requestor inquired as to whether the "proposed arrangement," as discussed below, would warrant sanctions under Sections 1128(b)(7) or 1128A(a)(7) of the Social Security Act (SSA) as they relate to the federal Anti-Kickback Statute (AKS). The opinion concludes that, if undertaken, the proposed arrangement would generate prohibited remuneration under the AKS.
October 01, 2024 at 11:37 AM
9 minute read
The HHS Office of Inspector General (OIG) issued Advisory Opinion No. 24-08 (opinion) on Sept. 10, 2024, regarding a "requestor's" proposal to share a percentage of its savings with certain groups to which it provides coverage. Specifically, the requestor inquired as to whether the "proposed arrangement," as discussed below, would warrant sanctions under Sections 1128(b)(7) or 1128A(a)(7) of the Social Security Act (SSA) as they relate to the federal Anti-Kickback Statute (AKS). The opinion concludes that, if undertaken, the proposed arrangement would generate prohibited remuneration under the AKS (if the requisite intent were present).
Factual Background
The requestor is a corporation which, on behalf of itself and its affiliates, contracts with the Centers for Medicare & Medicaid Services (CMS) to offer Medicare Advantage (MA) plans, MA-prescription drug (MA-PD) plans, and MA/MA-PD employer group waiver plans (EGWPs). The requestor provides health insurance coverage and administrative services to group health plans (groups).
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