Question Referral Gifts

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Hello my fellow AAPC Compliance Officers,

I had a question about whether it is legal for a Medical Billing company to offer a thank you gift to physicians who refer them to other medical practices. This is based on high level of satisfaction of their service and not that the billing company has campaigns to ask for referrals. I want to add that the billing company has no financial ties to these physicians. I looked everywhere for a direct and straight forward answer from OIG and found below. First it says 'OIG warns billing companies..' but it then states 'thus, the statute most likely would not be implicated by gifts to clients from a company that perform only billing service'. Billing companies submit on behalf of the doctor, however..

"1045.40.60 Gifts The OIG warns that billing companies should not confer gifts on the client-provider because it could raise anti-kickback concerns.85 However, the federal AKS applies only to payments and inducements for business that are reimbursable under state and federal health care programs. Thus, the statute most likely would not be implicated by gifts to clients from a company that performs only billing services. In United States v. Metzinger, 86 for example, the court rejected an anti-kickback claim arising from the coding/consulting company’s payment of a fee to individuals who referred additional hospital clients, holding that the anti-kickback law did not extend to suppliers of services that were not reimbursed by Medicare. However, a settlement agreement covering other allegations, including upcoding and unbundling, was later negotiated (see Metzinger Associates, § 1045.70.20)


The AKS might be implicated if a management company that itself owns health care facilities, such as ambulatory surgical centers, provides gifts to providerclients. Such gifts might be viewed as an inducement to refer patients to the management company’s facilities. The statute also might be implicated if a management company provides gifts to referral sources or patients as a means of inducing business for client-providers"



If someone can guide me to the statute, I would appreciate it!

Thank you.

Maryan
 

Evelyn Kim

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Local Chapter Officer
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Hello my fellow AAPC Compliance Officers,

I had a question about whether it is legal for a Medical Billing company to offer a thank you gift to physicians who refer them to other medical practices. This is based on high level of satisfaction of their service and not that the billing company has campaigns to ask for referrals. I want to add that the billing company has no financial ties to these physicians. I looked everywhere for a direct and straight forward answer from OIG and found below. First it says 'OIG warns billing companies..' but it then states 'thus, the statute most likely would not be implicated by gifts to clients from a company that perform only billing service'. Billing companies submit on behalf of the doctor, however..

"1045.40.60 Gifts The OIG warns that billing companies should not confer gifts on the client-provider because it could raise anti-kickback concerns.85 However, the federal AKS applies only to payments and inducements for business that are reimbursable under state and federal health care programs. Thus, the statute most likely would not be implicated by gifts to clients from a company that performs only billing services. In United States v. Metzinger, 86 for example, the court rejected an anti-kickback claim arising from the coding/consulting company’s payment of a fee to individuals who referred additional hospital clients, holding that the anti-kickback law did not extend to suppliers of services that were not reimbursed by Medicare. However, a settlement agreement covering other allegations, including upcoding and unbundling, was later negotiated (see Metzinger Associates, § 1045.70.20)


The AKS might be implicated if a management company that itself owns health care facilities, such as ambulatory surgical centers, provides gifts to providerclients. Such gifts might be viewed as an inducement to refer patients to the management company’s facilities. The statute also might be implicated if a management company provides gifts to referral sources or patients as a means of inducing business for client-providers"



If someone can guide me to the statute, I would appreciate it!

Thank you.

Maryan
As a fellow coder and a certified fraud examiner I would say be careful in giving gifts for referrals. It is important to avoid even the appearance of impropriety. It might be the better practice to send a thank you note and save the gifts for the holidays, then it is not tied to an activity such as a referral. Even though as a billing company, technically you are not being paid by CMS, the practice of giving a gift for a referral can be viewed as a bribe and subject to the AKS.

That being said, if the company insists on giving a gift for referral it should be spelled out explicitly in an agreement and be available to all providers equally. There should be clear guidelines as to how a provider can receive the gift.
 
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As a fellow coder and a certified fraud examiner I would say be careful in giving gifts for referrals. It is important to avoid even the appearance of impropriety. It might be the better practice to send a thank you note and save the gifts for the holidays, then it is not tied to an activity such as a referral. Even though as a billing company, technically you are not being paid by CMS, the practice of giving a gift for a referral can be viewed as a bribe and subject to the AKS.

That being said, if the company insists on giving a gift for referral it should be spelled out explicitly in an agreement and be available to all providers equally. There should be clear guidelines as to how a provider can receive the gift.
Thank you for your reply! its better to stay away than to take a risk.
 
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