Beneficiary Inducement Statute policy
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Establishes Hometown Health policies and procedures to comply with the Beneficiary Inducement Statute governing offers of remuneration to Medicare or state health care program beneficiaries; applies to Hometown Health staff, Board, FDRs, delegated entities and network providers.
No material clinical or coverage changes in this revision.
Beneficiary Inducement Compliance Criteria
Beneficiary Inducement compliance criteria
Policy statements and required actions when potential violations are identified:
Prohibitions, Investigation & Remediation
Prohibition on prohibited remuneration
Hometown Health, its employees, network providers and delegated entities are prohibited from offering or transferring remuneration to Medicare or state health care program beneficiaries when that remuneration is likely to influence the beneficiary to obtain items or services from a particular provider; remuneration includes items or services provided for free or for less than fair market value.
- Remuneration covered by the statute includes transfers of items or services for free or for other than fair market value.
- Prohibition applies to Hometown Health, its employees, network providers and delegated entities.
Investigation and remediation requirement
If Hometown Health identifies or discovers a potential violation of the Beneficiary Inducement Statute (including violations by delegated entities or network providers), the company will investigate and remediate the potential violation and will inform the government as appropriate.
- Investigation and remediation will be conducted for any identified potential violation.
- Notification to government authorities is included as part of remediation.
Governing Statute
| 42 U.S.C. § 1320a-7a(a)(5) | Beneficiary Inducement Statute (civil monetary penalties for offering remuneration to influence beneficiary to obtain items/services paid by Medicare or state health care program) |
Key Definitions
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