OIG Advisory Opinion 15-03 approves a Medigap insurer’s program that, among other things, calls for (a) network hospitals to waive the deductible for Medicare enrollees, (b) the insurer to pay the hospital network a fee each time it admits a Medicare enrollee, and (c) pay the Medicare enrollee $100 for being admitted.  The $100 would come in the form of a credit on the enrollee’s next policy premium.

The Opinion, posted March 2, didn’t come as a surprise, because it’s a mirror image of earlier Opinion No. 14-07, posted last August 25.  But it’s still somewhat puzzling.  After all, isn’t the hospital’s waiver of the deductible a form of inducement to send the enrollee its way?  And isn’t the insurer’s $100 credit to the enrollee an inducement to be admitted to the hospital?  We think of a deductible as a method of controlling overutilization, but this program works the opposite way: it gives an enrollee an incentive to become an inpatient.

Nevertheless, the Opinion blesses the program, assuring the insurer that there will be no sanctions under either the Anti-Kickback Statute or the Civil Monetary Penalties Law.  What’s the explanation?  The best guess is that it’s part the OIG’s concerted effort over the last year or so to do everything possible to help Medicare enrollees with skyrocketing health care costs.