HHS-OIG Declines to Approve Proposed Gainsharing Arrangement Involving Managed Care Organizations
This Bulletin is brought to you by AHLA’s Payers, Plans, and Managed Care Practice Group.
- December 19, 2024
- Stewart Kameen , Bass Berry & Sims PLC
- Jennifer Michael , Bass Berry & Sims PLC
The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently issued unfavorable Advisory Opinion 24-08, regarding a Medicare Advantage (MA) organization’s proposal to share a percentage of its savings with certain employer groups to which it provides coverage. Although OIG concluded that the proposed arrangement would implicate, and potentially violate, the federal Anti-Kickback Statute (AKS), it did not completely close the door on gainsharing arrangements in the managed care setting.
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