Beneficiary Inducements. Provider, Practice Providers, and Suppliers are prohibited from:
a. providing gifts or other remuneration to Beneficiaries as inducements for receiving items or services from or remaining in, the DCE or with Provider, Practice Providers, or Suppliers of the DCE or receiving items or services from DCE participants, Practice Providers, or Suppliers; they may, however, provide in-kind items or services to Beneficiaries if: (i) there is a reasonable connection between the items and services and the medical care of the Beneficiary; (ii) the items or services are preventive care items or services or advance a clinical goal for the Beneficiary, including adherence to a treatment regime, adherence to a drug regime, adherence to a follow-up care plan, or management of a chronic disease or condition; and (iii) the in-kind item or service is not a Medicare-covered item or service for the Beneficiary on the date the in-kind item or service is furnished to that Beneficiary. For purposes of this exception, an item or service that could be covered pursuant to a benefit enhancement is considered a Medicare-covered item or service, regardless of whether the DCE selects to participate in such benefit enhancement for a given performance year.
b. Conditioning the participation of Practice Providers or Suppliers on referrals of Federal health care program business that the DCE, Provider, Practice Provider, or Suppliers know or should know is being (or would be) provided to Beneficiaries who are not aligned with the DCE.
c. Except as permitted by the CMS Agreement, requiring that Beneficiaries be referred only to Provider, Practice Providers, or Suppliers within the DCE or to any other provider or Supplier.
Beneficiary Inducements. ACO Participant understands and agrees that in performing services for the ACO:
a. it and, if applicable, its ACO Providers/Suppliers are prohibited from providing gifts or other remuneration to beneficiaries as inducements for receiving items or services from the ACO or receiving items or services from ACO Participants or ACO Providers/Suppliers (unless expressly permitted by applicable law);
b. it and, if applicable, its ACO Providers/Suppliers are subject to review during the application process and periodically thereafter with regard to their program integrity history, including any Medicare programs exclusions or other sanctions and affiliations with individuals and entities that have a history of program integrity issues; and if the screening reveals a history of integrity issues or affiliations with a history of integrity issues it, he, she or they may be subject to denial from participation or the imposition of other safeguards or assurances;
c. it and, if applicable, its ACO Providers/Suppliers, and others performing functions or services related to ACO activities may not condition their participation in the ACO on referrals of federal health care program business that they may know or should know is being (or would be) provided to beneficiaries not assigned to the ACO.
