Medicare Compliance & Reimbursement

If you're about to ink a business deal with another health care provider that involves a "per patient" payment structure, you could be running serious risks under the anti-kickback statute. The HHS Office of Inspector General made that point once again in an advisory opinion released April 10 (No. 03-8). In the opinion, the OIG takes the measure of one company's proposal to develop and manage distinct part rehabilitation units located within acute care hospitals. The company's management fee would be based on a per patient, per day basis. That sounded quick alarm bells with the watchdog agency. "'Per patient,' 'per click,' 'per order,' and similar payment arrangements with parties in a position, directly or indirectly, to refer or recommend an item or service payable by a federal health care program are disfavored under the anti-kickback statute," the OIG warns. The agency notes that the deal may have passed muster under the safe harbor for personal services and management contracts if compensation was set in advance, consistent with fair market value, and not determined in a way that's based on volume.