Fraud Alert Issued Regarding Suspect Payments in MA and Provider Marketing Arrangements
(Dec. 20, 2024) – The Office of Inspector General of the U.S. Department of Health and Human Services has issued a special fraud alert to warn health care and insurance-related entities about certain fraud and abuse risks associated with marketing arrangements between Medicare Advantage Organizations and health care professionals and arrangements between HCPs and agents and brokers for Medicare Advantage (MA) plans.
These marketing arrangements involve questionable payments and referrals between MAOs, HCPs and third-party marketers that can mislead Medicare enrollees into choosing specific health plans or health care providers that may not meet the enrollees' needs. The OIG is concerned that parties involved may skew the guidance they provide to MA enrollees based on the parties' respective self-interests.
A significant risk area cited in the alert involves MAOs paying remuneration to HCPs, such as gift cards, for HCPs referring to or recommending patients to enroll in a particular MA plan. Additionally, the OIG highlights payments of concern from HCPs to agents and brokers in exchange for agents/brokers recommending that HCP be sent to a particular MA enrollee or referring the enrollee to the HCP.
You can view the fraud alert here, including reviewing suspect characteristics to be aware of to ensure fraud and abuse laws are upheld.
--Jaron Caffrey