Fraud & Abuse:
WATCH OUT FOR FREE PRE-OP VISITS
Published on Mon Mar 27, 2006
OIG gives thumbs down to widespread industry practice.
If you're one of the many home health agencies offering free visits to patients about to undergo orthopedic surgery, you could be inviting serious penalties from the feds.
Free pre-operative safety assessments implicate civil money penalty (CMP) sanctions and the anti-kickback statute, the HHS Office of Inspector General says in Advisory Opinion No. 06-01 posted March 27.
"There are thousands of HHAs who are doing this," notes attorney Liz Pearson with Pearson & Bernard in Covington, KY. They "need to know that they will have to cancel their services."
Although Medicare and Medicaid don't cover the free pre-op home safety assessments, they do cover many postoperative home care items and services, the OIG notes in the opinion. "Arrangements whereby a prospective provider or supplier of Federally payable items and services offers beneficiaries a non-covered item or service free of charge implicate the fraud and abuse laws and must be closely scrutinized."
Furthermore, the national chain that requested the opinion should know it's a problem, the OIG says. The arrangement, "including offering the service without charge, obtaining a recommendation from the patient's own health care professional, and using physical therapists to perform the services--appear calculated to generate postoperative business" for the company, the OIG adds.
Giving away free initial services to increase the chance that the client will choose the provider for later services is a common business tactic, notes attorney Robert Markette Jr. with Gilliland Markette & Milligan in Indianapolis. "OIG noted that the free assessment 'maximized' the agency's opportunity to initiate a relationship with a patient," Markette says. "Once again, what is simply good business in any other profession, is a crime for Medicare providers.
What they're doing: The unnamed home care company requested the opinion based on its practice of having PTs conduct a pre-op home safety assessment either in the home or over the phone. The assessment includes gathering basic patient information such as surgical history and falls history and basic residence information such as number of stories and steps and tripping hazards. The PTs might offer simple home improvement suggestions like removing throw rugs.
The pre-op visit program described in the advisory opinion is similar to most HHAs' pre-op programs, "so the impact is nationwide," Pearson warns.
The OIG's opinion shows "a lack of understanding about what is required for patients to be appropriate for home health services," protests Burtonsville, MD-based health care attorney Elizabeth Hogue. HHAs must make sure post-op patients have a caregiver to care for them between agency visits and a safe home environment to support home care services.
Checking on and securing those elements are "likely appropriate coordination activities, not 'free safety assessments' like those described in the Advisory Opinion," Hogue maintains. Notices Not [...]
