Oak Street Health's $60M Settlement Highlights Compliance Risks in Medicare Advantage
Weekly snippets from the Insurance Compliance Insight (ICI) Newsletter. A weekly subscription service published by an insurance compliance professional for insurance compliance professionals!
The recent $60 million settlement by Oak Street Health serves as a stark reminder of the compliance risks inherent in the Medicare Advantage (MA) space. As reported in the September 30, 2024, edition of Insurance Compliance Insight, this CVS Health subsidiary faced allegations of paying kickbacks to insurance agents for patient referrals, violating the False Claims Act and Anti-Kickback Statute.
This case underscores the importance of robust compliance programs in healthcare organizations, especially those dealing with federal programs like Medicare Advantage. The "Client Awareness Program" implemented by Oak Street Health, while ostensibly aimed at increasing patient membership, crossed legal boundaries by incentivizing agents to prioritize the company's financial interests over patients' needs.
For compliance professionals in the insurance and healthcare sectors, this settlement highlights several key points:
The need for thorough vetting of marketing and referral programs
The importance of aligning incentives with patient interests, not just company growth
The ongoing scrutiny of Medicare Advantage providers by federal authorities
As the MA market continues to grow, companies must ensure their practices prioritize patient care and comply with federal regulations. This case serves as a cautionary tale and a call to action for strengthening compliance measures across the industry.
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