Posted on Friday, January 6, 2017 5:55 PM
The value of items or non-monetary services that can be provided to Medicare and Medicaid beneficiaries without an agency risking violating the law, were increased according to the updated guidance from the HHS Office of Inspector General (OIG). The new cap on an increased item by $5 – is now increased to a maximum of $15.
The December 7 update should remind agencies and other providers to re-evaluate what the OIG considers appropriate items and services to provide beneficiaries.
Agencies that provide items of value greater than what the OIG permits violate the law prohibiting inducement of beneficiates with valuable items or services. They could be subjected to civil monetary penalties of up to $10,000 for each wrongful act, according to the OIG.
Although the increase is not that significant, it does allow agencies more opportunity to provide goods or services to clients.
Initially, these types of benefits may not lead to immediate referrals, but they may lead to word-of-mouth referrals.
To view the December 7 update, click here.
Why the OIG cares about inducements in a special advisory bulletin in 2002 called “Offering gifts and other inducements to beneficiaries,” the OIG explained that providing patients “valuable” gifts was problematic for two reasons.
The OIG noted the following:
• Providing such gifts raises cost and quality concerns because there is a potential “economic incentive” for providers to perform unnecessary or lower quality services to offset the cost of the gifts
• The practice of providing patients valuable gifts creates an unfair playing field “favoring large providers with greater financial resources”
To read the 2002 bulletin, click here.
Take note of the following exceptions from OIG Beyond the “nominal value” rule:
• Non-routine and unadvertised waivers of copayments or deductibles
• Incentives that are part of health plans with “preferred providers”
• Incentives to promote delivery of preventive care
The Guide to Clinical Preventative Services is available here.
For the full article, please see the January 9, 2017 Home Health Line Edition.
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