Home Health & Hospice Week

Home health agencies may think they aren't affected by the OIG's recent report on potential improper relationships between hospices and nursing homes, but they should think again.

It's true that HHAs generally can't serve Medicare beneficiaries that reside in nursing homes, acknowledges attorney Robert Markette Jr. with Benesch/Dann Pecar in Indianapolis. But the hospice-nursing home relationship looks very similar to the one between HHAs and assisted living facilities, Markette points out.

"HHAs can find themselves pressured to take marginal home health patients as a 'favor' to an ALF," Markette cautions. "The fact that the ALF controls a large number of potential referrals can lead to a great deal of pressure for agencies to accept these marginal patients."

Agencies may also feel leaned on to provide "freebies" to ALF residents at the facility's request, Markette adds.

Either of these situations can land HHAs squarely in the feds' crosshairs. "Admitting nonhomebound patients has been a longstanding concern of OIG," Markette points out. And freebies "can lead to kickback issues, such as providing free or below-cost staffing to the facility."

Since the OIG is investigating hospice-nursing home relationships, "the manner of obtaining referrals and the business relationships ... between ALFs and HHAs may be subject to scrutiny," too, predicts attorney Marie Berliner with Lambert & Berliner in Austin, Texas.

More HHAs will be affected by these issues as they expand into the hospice market as well, points out attorney Todd Selby with Hall Render in Indianapolis. "Home health providers are actively acquiring hospice providers."

And when HHAs and hospices are under common ownership, they may also face compliance risk areas involving admitting patients too soon to the benefit, Selby adds. "HHAs are ... going to be under pressure to push patients to hospice given the extreme payment cuts that HHAs are facing."