Medicare Compliance & Reimbursement
CMS POLICY TRUMPS STRICT ANTI-KICKBACK ANALYSIS
A recent issuance from the HHS Office of Inspector General illustrates that the anti-kickback statute can be so broad that it technically bars certain activities the Centers for Medicare & Medicaid Services actually wants to see happen.
In an advisory opinion released Feb. 12 (No. 03-04), the OIG takes the measure of a home health agency’s proposal to provide free medicalalert pagers and service to patients.
The pagers would “facilitate a rapid response” when patients have fallen, injured themselves or otherwise need emergency assistance, the watchdog agency explains in the opinion. Thus, it would stave off more expensive care down the road.
The problem is that the cost of the pagers and service, which the HHA plans to offer through a third-party vendor, is estimated at up to $360 per year. That figure obviously exceeds the OIG’s threshold, outlined in a special advisory bulletin released last August, of $50 per year, per patient for free items and services.
Fortunately for the HHA, however, CMS’ own HHA manual declares that an agency “may adopt telehealth technologies that it believes promote efficiencies or improve quality of care.”
In part because CMS expressly encourages “innovative telehealth technologies,” the opinion says the OIG wouldn’t impose penalties for offering this service to patients.
To see the opinion, go to http://oig.hhs.gov/fraud/docs/advisoryopinions/2003/ao0304.pdf.
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