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OIG Issues Favorable Opinion Regarding Waivers of Co-Payments and Other Cost Sharing Amounts By a Charity Hospital

The OIG recently issued a favorable opinion concerning (1) the waiver of patient cost sharing amounts, without regard to patient need and (2) providing limited lodging and transportation for all patients of a network of pediatric charity hospitals.  The requestors were pediatric non-profit charity hospitals which currently provide free services to very sick and injured children.

The Requestors have not billed for their services in the past, but were seeking a favorable determination so that they could begin to bill on an “insurance only” basis without billing the patients or families for copayments, deductibles or other cost sharing amounts.  They would also continue to provide free services to uninsured patients and would not make decisions as to which families could receive the service based on insured status.

The OIG concluded that the Insurance-Only Billing would not lead to a risk of improper billing since the hospitals historically have not charged the patients or their families for services.

The OIG’s opinion was also favorable with regard to the proposed lodging and transportation assistance based on an analysis pursuant to the recent revision in the Civil Monetary Penalty law, resulting from the Patient Protection and Affordable Care Act (PPACA), which excepts remuneration “which promotes access to care and poses a low risk of harm to patients and Federal healthcare programs.”

This decision has limited applicability because of the unique nature of the healthcare providers at issue.  If you have questions regarding waiver of co-payments or deductibles, financial need policies or issues related to the provision of free transportation or free lodging, please contact one of our healthcare law attorneys at 248-544-0888 or www.Wachler.com