Medicare Compliance & Reimbursement

Home health agencies could get on board with this. 

In the past, a provider that offered free home safety equipment to patients might expect a knock on the door from the OIG. But the healthcare reform legislation opens the door for providers to give financially needy Medicare or Medicaid patients free, non-covered items or services related to their medical care. A couple of OIG advisory opinions have frowned on those types of arrangements, says attorney Robert Belfort, with Manatt, Phelps & Phillips LLP in New York City. Under the healthcare reform law's new exception, however, a home health agency (HHA), as an example, could provide a free safety evaluation of a patient's home, he says. Or the HHA could install home safety equipment that could make it safer for the patient to live there. "Arguably, it would be to the patient's benefit to keep them in the home so they don't have to go a nursing home," says Belfort.

A hospice example: "A hospice might be able to provide information regarding resources in the community, such as a social worker might provide," says attorney Marie Berliner, with Lambeth & Berliner PLLC in Austin, Texas.

To comply with the new exception, the free services or items (or ones provided below fair market value) can't be " tied to the provision of other services reimbursed in whole or in part" by Medicare or Medicaid, according to the legislation. And the services or items have to be reasonably related to the person's medical care. The provider also has to limit the services or products to financially needy patients.

Unless the regulations say otherwise, the provider would come up with "reasonable" criteria for identifying patients with financial need, says Belfort. Berliner also thinks providers will need "uniform parameters" for determining financial need, which they apply consistently.

Also: The law specifically notes that the provider can't offer the items or services "as part of any advertisement or solicitation."