On December 12, 2024, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) published a Special Fraud Alert1 targeting Medicare Advantage (MA) marketing arrangements involving payments for referrals of MA beneficiaries (1) from Medicare Advantage Organizations (MAOs) to healthcare professionals (including individual physicians and physician groups) (HCPs) and (2) from HCPs to MA plan agents and brokers.
This Special Fraud Alert follows a growing wave of government enforcement activity under the False Claims Act (FCA) of the MA industry, in particular related to arrangements involving payment for referrals of MA beneficiaries. HHS-OIG rarely issues Special Fraud Alerts, signaling that these arrangements present particularly heightened enforcement risk.
