In October, The Department of Health and Human Services Office of Inspector General (OIG) issued a policy statement to explain specific conditions when hospitals can discount or waive fees owed by Medicare beneficiaries for self-administered drugs received in outpatient settings without being subject to federal anti-kickback sanctions. This applies to self-administered drugs that are not covered by Medicare Part B, including drugs that may be covered under Medicare Part D.
It was stated that the policy was designed to address the question whether various guidance issued by the Centers for Medicare & Medicaid Services (CMS) require hospitals to bill and collect (or make good faith efforts to collect) usual and customary charges for non-covered self-administered drugs to comply with OIG’s fraud and abuse authorities.
Hospitals WILL NOT be subject to OIG administrative sanctions for waiving part or all of what a Medicare patient owes for non-covered self-administered medications IF the following conditions are met:
The policy applies only to discounts on, or waivers of, amounts Medicare beneficiaries owe for non-covered self-administered drugs that the beneficiaries receive for ingestion or administration in outpatient settings;
Hospitals must uniformly apply their policies regarding discounts or waivers on non-covered self-administered drugs (e.g., without regard to beneficiary’s diagnosis or type of treatment);
Hospitals must not market or advertise the discounts or waivers; and
Hospitals must not claim discounted or waived amounts as bad debt or otherwise shift the burden of these costs to the Medicare or Medicaid programs, other payers, or individuals.
The policy clarifies that hospitals are not required to discount or waive amounts owed by Medicare beneficiaries and that the policy does not affect the ability of a hospital to discount or waive any amounts owed by Medicare beneficiaries on the basis of a good-faith, individualized determination of a beneficiary’s financial need.
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