Kickbacks:
PROTECT YOURSELF AS CMS EYES MEDICAL DIRECTORS
Published on Thu Apr 28, 2005
Going overboard on number of directors raises a red flag.
The newest compliance hotspot for home care providers is medical director kickbacks.
As seen in the recent whistleblower lawsuit against Monroe, LA-based Aging Care Home Health Inc., Medicare can all but shut down your cash flow if charges of medical director kickbacks arise (see Eli's HCW, Vol. XIV, No. 15).
In response to provider requests, the Centers for Medicare & Medicaid Services addressed the issue of medical director kickback fraud in the April 21 Open Door Forum for home care providers.
Recently, CMS has suspected home health agencies of paying physicians for referrals through sham medical directorships, a CMS official warned in the forum. "You need to hire a physician when you need work to be done," the staffer stressed. "Be sure what you hire them for is for the work and not for anything else but the work."
Gene Tischer of the trade association Associated Home Health Industries of Florida called in with medical director horror stories, where agencies are paying physicians up to $5,000 per month for directorships. In one case, an HHA with a census of 200 had 27 medical directors, Tischer related in the forum, which drew more than 185 callers.
The "medical director position is being abused a lot," Tischer claimed. Stiff competition for referrals in many areas is spurring the illegal activity, he theorized. Take Out a Timesheet Insurance Policy The CMS official urged listeners to determine the reasonable amount of medical director work an agency of their size requires, then hire physicians to perform the work.
If directors work part-time for the agency, then having multiple directors to perform tasks might make sense, she said. But if multiple directors are performing redundant work, that's a red flag.
When asked if medical director timesheets are necessary, CMS responded that timesheets aren't required but are a very good idea. Although a specific tool isn't mandated, "what really matters is that if we ever investigated you, you could show us ... the work the physician had done," the official explained.
CMS recommended medical directors meet these requirements, included in the personal services safe harbor to the anti-kickback statute:
Have an agreement with the director in writing.
The agreement must clearly describe the phys-ician's duties and tasks as medical director.
The duties must be commercially reasonable and not trumped-up tasks. "The work they do has to be real work," the CMS staffer stressed.
Compensation must be fair market value and not take into consideration any referrals.
The compensation must be set for a year in advance - no changes after six months, for example.
Action urged: Tischer appealed to CMS to start getting a handle on the kickback problem by requesting medical director information as [...]
