Ask the Expert: Paying Patient Premiums
Question: Do anti-kickback laws preclude providers from paying premiums for uninsured patients, specifically for the health insurance marketplace plans?
Answer 1: On March 14, 2014, the Centers for Medicare and Medicaid Services issued an interim final rule on premium subsidies requiring qualified health plans to accept premiums paid by third parties on behalf of enrollees in certain programs such as the Ryan White HIV/AIDS Program or urban Indian organizations. The rule did not, however, require that insurers accept payments by private third parties (e.g., hospitals and health systems) and reiterated its concern that hospital payments of premiums would skew the insurance market.
Subsequently, in May 2014, Department of Health and Human Services Secretary Kathleen Sibelius wrote a letter to the American Hospital Association indicating that third-party premium assistance structured to follow the independent charity safeguards in Office of Inspector General advisory opinions are permitted under applicable rules. We have had no further guidance since then. Therefore, the safest route is for hospitals to be able to refer patients in need of premium assistance to an independent charity that will provide assistance based on consistent indication of need. Providers who are giving premium assistance on their own can lessen their anti-kickback risk by providing aid to those already admitted to the hospital based on consistent criteria, rather than seeking out “frequent fliers.”
This question was answered by: Elizabeth M. Mills, chair, Proskauer Rose LLP, Chicago, and a member of HFMA’s First Illinois Chapter.
Answer 2: I advise clients to make one-time payments of patients’ overdue premiums and then bill patients for the payment amounts. This procedure does not skew the risk pool and it is unlikely to violate anti-kickback laws.
This question was answered by: Robin A. Johnson, principal, The Health Law Group, Hopkinton, Mass.
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