HHS’s mixed messages:identifying a federal healthcare program when you see it
Recent seemingly contrary determinations by the U.S. Department of Health and Human Services (HHS) have fueled industry speculation regarding whether qualified health plans (QHPs) available on the health insurance exchanges would be considered “federal health care programs,” and thus subject to the various fraud and abuse laws applicable to such programs, including the federal anti-kickback statute.
A QHP’s status as a federal healthcare program has been of particular interest to providers that may be considering subsidizing QHP premiums for individuals purchasing coverage on the marketplace. Federal law generally defines a “federal health care program,” as “any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government” (other than the Federal Employee Health Benefits Program). If QHPs are found to be federal healthcare programs, such practice could arguably expose providers to sanctions under the anti-kickback statute, which is a broadly worded prohibition on the offer, payment, solicitation or receipt of remuneration intended to influence the referral of items or services to be paid for by a federal healthcare program.
Courtesy of http://www.lexology.com/