Offers and pricing: what rule CG-OIG-102 checks

CG-OIG-102 · Blocks approval · Citation checked against stored text

OIG warns about payments from health care professionals to agents and brokers to recommend or refer Medicare Advantage enrollees to the professional, for example to be named an enrollee's primary care provider. Enrollees often do not know about the payment. DOJ settled with Oak Street Health for $60 million over allegations it paid agents about $200 per referred beneficiary. Applies to providers, agents and brokers.

Source: OIG Special Fraud Alert (December 2024) on suspect payments in marketing arrangements related to Medicare Advantage and providers, part III; 42 U.S.C. 1320a-7b(b); DOJ Oak Street Health settlement (September 18, 2024)

Safer wording: Do not pay agents or brokers per referral, per enrollee or per patient steered to your practice. If you use an agent, pay only compensation that CMS rules and counsel have cleared, and never tie it to which provider the enrollee picks.

Oak Street Health settlement, 42 U.S.C. 1320a-7b · Needs counsel review