Medicare and state health care programs: fraud and abuse; safe harbors for protecting health plans--HHS. Interim final rule with request for comment.
In accordance with section 14 of the Medicare and Medicaid Patient and Program Protection Act of 1987, this interim final rule establishes two new safe harbors and amends one existing safe harbor to provide protection for certain health care plans, such as health maintenance organizations and preferred provider organizations. The first new provision protects certain incentives to enrollees (including waiver of coinsurance and deductible amounts) paid by health care plans. The second new provision protects certain negotiated price reduction agreements between health care plans and contract health care providers. Finally, an existing safe harbor has been amended to protect certain agreements entered into between hospitals and Medicare SELECT insurers. These safe harbors specifically set forth various standards and guidelines that, if met, will result in the particular arrangement being protected from criminal prosecution or civil sanctions under the anti-kickback provisions of the statute.
D014487:Centers for Medicare and Medicaid Services, U.S.; D003284:Contract Services / Q000191:economics / Q000331:legislation & jurisprudence; D003361:Cost Allocation / Q000331:legislation & jurisprudence / Q000379:methods; D005377:Financial Management, Hospital / Q000191:economics / Q000331:legislation & jurisprudence; D005607:Fraud / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D016365:Liability, Legal; D008329:Managed Care Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence*; D013221:State Health Plans / Q000331:legislation & jurisprudence; D014481:United States