Health insurance providers and out-of-network providers, have found themselves in murky water by providing waivers of co-payments, coinsurance, and deductibles to patients treated by out-of-network laboratories and other providers, where commercial insurers continue to seek legal reimbursement actively, recovery and collection claims against such providers, alleging in pertinent part False Claims Act (“FCA”), Anti-Kickback Statute Violations (“AKS”), and other legal claims. Such efforts are requiring Courts to identify, determine, evaluate, and when waivers of co-payments, coinsurance, and deductibles, constitute such FCA and AKS violations.
It is no secret that health insurance is getting more expensive, especially as insurance payers seek to shift more of the cost burden to patients. This burden shifting exercise has caused waivers of co-payments, coinsurance, and deductibles to be more in vogue than ever before. However, use of waivers is not a new practice but historically, and more so in recent years, it has been an effective means to address the “difficult economic environment [where] many health care providers are actively trying to increase cash flow and reduce administrative expenses.”
Read the full article in the January 2017 issue of Life Science Compliance Update.