MARCH 2026 | 11 THE OKLAHOMA BAR JOURNAL Statements or opinions expressed in the Oklahoma Bar Journal are those of the authors and do not necessarily reflect those of the Oklahoma Bar Association, its officers, Board of Governors, Board of Editors or staff. following practices: 1) advertisements that state, “Medicare Accepted as Payment in Full,” “Insurance Accepted as Payment in Full” or “No Out‐of‐Pocket Expenses”; 2) advertisements that promise that “discounts” will be given to Medicare beneficiaries; 3) the routine use of “financial hardship” forms, which state that the beneficiary is unable to pay the coinsurance/deductible (i.e., there is no good faith attempt to determine the beneficiary’s actual financial condition); 4) the collection of copayments and deductibles only when the beneficiary has Medicare supplemental insurance (Medigap) coverage (i.e., the items or services are “free” to the beneficiary); 5) charges to Medicare beneficiaries that are higher than those made to other persons for similar services and items (the higher charges offset the waiver of coinsurance); and 6) the failure to collect copayments or deductibles for a specific group of Medicare patients for reasons unrelated to indigency (e.g., a supplier waives coinsurance or deductible for all patients from a particular hospital in order to get referrals). The OIG has indicated that it will not enforce the Civil Monetary Penalties Law (CMPL) and the AKS against providers who waive copays and deductibles based on the legitimate and documented financial hardship of the patient. The CMPL specifically excludes from the definition of “remuneration” the waiver of copays and deductibles if all of the following conditions are satisfied: 1) The waiver is not offered as part of any advertisement or solicitation, 2) the person does not routinely waive coinsurance or deductible amounts and 3) the person a) waives the coinsurance and deductible amounts after determining in good faith that the individual is in financial need or b) fails to collect coinsurance or deductible amounts after making reasonable collection efforts.12 On July 8, 2024, the OIG updated its “General Questions on Fraud and Abuse Authorities” (FAQs)13 related to the AKS and the CMPL with clarifications regarding waiving patients’ cost-sharing amounts pursuant to health care providers’ financial assistance policies. In the new FAQs (specifically Nos. 13-16), the OIG cites the AKS safe harbor and CMPL exception for waivers of cost-sharing amounts, which permits providers to waive patients’ cost-sharing amounts, provided that the waivers are not routine, not advertised, and made based on a good-faith, individualized assessment of financial need. Generally, it’s recommended that providers draft and implement a financial assistance policy that is consistently followed to make sure all patients in similar situations are addressed in the same manner and that proper documentation of a patient’s need is obtained. Using the federal poverty level is a good benchmark, but providers can incorporate “presumptive” categories of people entitled to financial assistance in their financial assistance policies, such as those on Medicaid. Providers can and often do add or permit other categories, such as the high cost of care and other special circumstances. CONCLUSION Health care law is not for the uninitiated. Its idiosyncrasies can turn otherwise routine legal work into a minefield for the unsuspecting practitioner, and the above examples are just the tip of the iceberg. Health care providers can also face steep fines or other consequences for seemingly innocuous oversights, like: Forgetting to sign a contract14 Forgetting to check this database,15 or this one,16 and (just to be safe) this one,17 this one,18 and this one too,19 prior to hiring or contracting with certain individuals No one hates social media more than a hospital’s privacy officer.
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