Sweetening The Deal

It happens all the time. Home health marketers do their best to stay on the radars of current or prospective clients. They develop strong relationships with doctors, social workers and discharge planners at treatment and rehab facilities, usually with regular phone calls and visits. When it comes time for a patient to be discharged, they want the referrals. They are just doing their job. Sometimes, however, “pampering” is involved. Staff members are offered any number of gifts, such as gift cards, spa days, restaurant dinners, or events (e.g., theater, sports). The understanding, explicit or tacit, is that these special incentives will result in a future referral.

A Dangerous Game

According to the law firm Davis Graham & Stubbs, when staff members return the “favor” with a referral, they either give the patient no choice or limit the patient’s choices to the two or three home health companies from which they have received gifts.¹ View/Download the Davis, Graham & Stubbs Memo (PDF)

In addition to the unfairness of such a situation for a patient, the practice blatantly violates the Anti-Kickback Statue. This law:

1. Mandates that patients have the freedom to choose their home health company
2. Prohibits the acceptance of items of monetary value for the purpose of inducing referrals

Even if it doesn’t result in a referral, accepting a gift – however small – from a home health marketer is illegal.² Not only can it jeopardize participation in Medicare programs, state licensing and the accreditation of your facility. It can also lead to an investigation of your facility by the OIG, along with the criminal indictment of one or more staff members. Each violation can carry a fine of up to $250,00 and/or five years in prison.

Steering a patient in a particular direction because of a relationship with a home health marketer is dangerous. Even a referral in exchange for free planning services in the discharge process is a violation of the law.

Are You at Risk?

What are the chances of the OIG going after a social worker or discharge planner? It happened not long ago in Chicago.³ A social worker came under investigation because a home health company was making large gifts to facilities all over the city. As soon as a home health company goes under investigation, the OIG examines every single monetary distribution – and every single recipient. In this particular case, the social worker was indicted for accepting $1800 over a six-year period. That amounts to less than one $25 gift card per month. The facility which employed that social worker had to pay steep fines – or lose it’s Medicare accreditation. View/Download the OIG Case 06272012 docment (PDF)

The CareNextion App: A Smart, Simple Move

The CareNextion App ensures that your facility stays in compliance. Because it provides unbiased information (including ratings) on all of the companies which serve a patient’s specific geographical location and physical needs, it offers conclusive proof that you are offering your patients freedom of choice. When a patient uses the CareNextion App, the choice form serves as an electronically verifiable document.

Don’t run the risk. With the CareNextion App you, your staff and your facility are protected.

1. Merritt, E. (2012, November 28). Memo: Legal risks associated with inappropriate referrals for post-acute care.
2. Ibid
3. U.S. Department of Justice. (2012). Owners of two Chicago home health care agencies and three doctors among 10 charged in alleged Medicare kickback schemes [Press release].