Home Health & Hospice Week

Paying referral sources for speaking at in-services will land you under increased scrutiny.

When one thinks of ways fraudsters disguise kickback payments to referral sources in the home health and hospice industry, medical director compensation may come to mind first. But another source of payment should also be on your radar — because it is on the feds’.

An HHS Office of Inspector General Special Fraud Alert issued Nov. 16 “highlights the fraud and abuse risks associated with the offer, payment, solicitation, or receipt of remuneration relating to speaker programs,” it says. “Speaker programs are generally defined as company-sponsored events at which a physician or other health care professional (collectively, ‘HCP’) makes a speech or presentation to other HCPs about a drug or device product or a disease state on behalf of the company. The company generally pays the speaker HCP an honorarium, and often pays remuneration (for example, free meals) to the attendees.”

The practice is big in drug companies, points out attorney Robert Markette with Hall Render in Indianapolis. The OIG also singles out medical device companies in its Alert.

But home care providers engage in this also, maintains home health financial expert Tom Boyd, CEO of Aftercare Nursing Services. This is “seen often where MDs [are] paid to do in-services for staff or ‘community,’” Boyd tells AAPC.

“Our investigations have revealed that, often, HCPs receive generous compensation to speak at programs offered under circumstances that are not conducive to learning or to speak to audience members who have no legitimate reason to attend,” the OIG says in the Alert. “Such cases strongly suggest that one purpose of the remuneration to the HCP speaker and attendees is to induce or reward referrals.”

Conclusion: “This remuneration to HCPs may skew their clinical decision making in favor of their own and the company’s financial interests, rather than the patient’s best interests,” the OIG says.

Warning: “Parties involved in speaker programs may be subject to increased scrutiny,” the OIG says. That includes the companies paying, the speakers, and the attendees, the agency stresses.

Red flags that indicate a speaking event may be violating the anti-kickback statute include inclusion of alcohol, especially if it’s free; meals exceeding a “modest value;” speakers or attendees repeating topics; “the company’s sales or marketing business units influence the selection of speakers;” referrals generated influence speaker selection; and payment that is higher than fair market value for the speaker.

The OIG does acknowledge that such speaking events have decreased under COVID. But “the risks associated with speaker programs will become more pronounced if companies resume in-person speaker programs or increase speaker program-related remuneration to HCPs,” the watchdog agency says.

Note The 7-page alert is at www.oig.hhs.gov/fraud/docs/alertsandbulletins/2020/SpecialFraudAlertSpeakerPrograms.pdf.