Free introductory visits offered by one home health care provider don’t violate the anti-kickback statute or the civil monetary penalties law, according to an advisory opinion recently issued by the Department of Health and Human Services Office of Inspector General (OIG).
The opinion comes following a ruling on home health referrals earlier this year in which providers were put more at risk of violating the anti-kickback statute, and a historic $712 million fraud takedown that included such infractions.
The OIG responded to a request for review of a home health provider’s policy to offer initial visits to patients at no charge, specifically as it relates to the civil monetary penalty provisions that ban bribes to beneficiaries. The opinion issued applies only to the provider in question, the OIG report emphasized.
The anti-kickback statute prohibits the payment, solicitation or receipt of money to induce referrals of items or services that can be reimbursed by a federal health care program. The civil monetary penalties law comes into play if payments are extended to a Medicare or state health care program beneficiary in a way likely to influence his or her selection of a particular provider.
“We believe that the introductory visits do not provide any actual or expected benefits to patients, and therefore do not constitute renumeration,” wrote Gregory E. Demske, chief counsel to the Inspector General.
In the opinion, the OIG found that the provider’s practices are not in violation of either regulation, namely because the main purpose of the free introductory visits is to ease a patient’s transition to home health services and familiarize him or her with the care team. The OIG also stated that patients have already selected the provider as their home health provider when the initial visit is conducted, meaning referrals are not being induced.
Further, services administered during this provider’s first visit are ineligible for federal reimbursements, according to the opinion.
“The introductory visits are a logical and reasonable first step in the care relationships that have been established,” Demske wrote.
Written by Kourtney Liepelt
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Department of Health and Human Services Office of the Inspector General
