Offers and pricing: what rule CG-OIG-101 checks

CG-OIG-101 · Blocks approval · Citation checked against stored text

OIG warns that a Medicare Advantage plan paying doctors or their office staff, in gift cards or in kind, to refer or recommend patients for enrollment can violate the federal anti-kickback statute and steer people into plans that do not fit them. CMS also bars a provider acting for a plan from accepting compensation for marketing or enrollment. Applies to plan sponsors, agents and providers.

Source: OIG Special Fraud Alert (December 2024) on suspect payments in marketing arrangements related to Medicare Advantage and providers, part II; 42 CFR 422.2266(d)(1)(ix); 42 U.S.C. 1320a-7b

Safer wording: Do not pay or reward providers or their staff for recommending a plan or for enrollments. Describe plans on their merits and tell people they can compare plans at medicare.gov.

42 CFR 422.2266, 42 CFR 422.2266(d)(1)(ix), 42 U.S.C. 1320a-7b · Needs counsel review