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From Health Law Daily, August 14, 2015

Nice to meet you: free introductory visit not remuneration

By Kayla R. Bryant, J.D.

A particular home health provider’s plan to offer free introductory visits to new patients is not a violation of the Social Security Act. The HHS Office of Inspector General (OIG) issued an advisory opinion stating that it does not plan to pursue sanctions, including the imposition of civil money penalties (CMPs), on this home health provider for this arrangement. Only the provider requesting the opinion may rely on it, and the OIG warned that this opinion is only limited to the facts presented by the requestor (OIG Advisory Opinion, No. 15-12, August 6, 2015).

Selection. The home health provider is a for-profit entity that provides services to patients, including those participating in Medicare, Medicaid, and other federal health care programs. In general, a physician or other professional serving as a hospital discharge planner or case manager presents a list of possible providers to a patient that plans to transition to home health services. The health care professional contacts the requestor if it is the chosen provider. In the submission, the requestor certified that it is not part of the selection process and that it does not pay referral sources to induce patients to select it as the provider.

Introductory visit. Under the plan, an employee of the requestor inquires if the patient would like an introductory visit, either conducted in person or by phone or email. The purpose of the visit is to facilitate the transition to home health services and ensure compliance with the post-acute treatment plan. During the introductory visit, a requestor employee provides an overview of home health care, provides written materials listing contact information for relevant employees, and shares pictures of the care team that will be providing services. There are no diagnostic or therapeutic services offered during the introductory visit. Although the particular employee that handles the introductory visit is a licensed practical nurse, the duties required to handle the introductory visit do not require clinical training. The introductory visit is not reimbursed by Medicare, Medicaid, or third-party payers. The costs of offering the visit are not listed on cost reports and the burden is not shifted to any payers or patients.

Anti-kickback statute. The anti-kickback statute (42 U.S.C. §1320a-7b) prohibits offering or receiving any remuneration to induce referrals of services that may be reimbursed by a federal health care program. Conviction for violation of the statute may result in a fine up to $25,000 and imprisonment up to five years, or both, as well as automatic exclusion from federal health care programs. The OIG may also impose CMPs on a violating party.

No inducement. There is no violation of the statute if remuneration is not offered, paid, solicited, or received. The OIG does not believe that the introductory visits provide any economic benefit to patients, and therefore are not considered remuneration. The patients only receive information about the employees and an overview of the experience. There are no actual home health services rendered. While the OIG noted that the introductory visits might have some intrinsic value to patients, it believed that nothing in the visit provided more than services of nominal value and that this arrangement is distinguishable from other possibly problematic arrangements. The OIG concluded that this arrangement would not subject the home health provider to sanctions or penalties, and that it would not pursue action against the provider in relation to this arrangement.

MainStory: TopStory HomeNews AntikickbackNews CMSNews FraudNews PartANews PartBNews MedicaidNews ProviderNews

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