Home Health & Hospice Week

Providers that furnish a wide array of services may be able to pay for referrals to their non-federally paid business lines, a new Advisory Opin-ion from the HHS Office of Inspector General suggests.

In the opinion, a company that has a variety of senior living and nursing facilities asks if it’s OK to pay a third party placement agency for referrals to its facilities that don’t take federal or state reimbursement from Medicare or Medicaid. The possibility exists that while the referred patients currently don’t receive services reimbursed federally, they could progress to that stage and receive services from another business line in the company that does take Medicare and Medicaid reimbursement — namely, a skilled nursing facility or therapy offered by SNF therapy staff.

The conclusion: Paying for these referrals is OK, because the company stipulates that the referred patients must not be federally funded at all at the time of referral, the OIG says in the opinion. The arrangement is also acceptable because the fee for the referral is based on the patient’s first month or two of non-federally-paid services.

Finally, since the referral is to the communities that don’t take any federal funds at all, the OIG gives the arrangement a thumbs up. "Whether an individual resident originally placed by the Placement Agency will receive Federally payable services provided by an Affiliated Entity at some point in the future, due to a change in circumstances, is substantially speculative and outside the control of the Placement Agency," the OIG judges.

Resource: The opinion is online at http://oig.hhs.gov/fraud/docs/advisoryopinions/2014/AdvOpn14-01.pdf.