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The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has issued an advisory opinion that supports an arrangement under which a vendor of technology platforms proposed to contract with hospitals to provide services to patients following hospital discharge.
The OIG concluded that it would not impose penalties under the Anti-Kickback Statute even though the arrangement potentially could generate prohibited remuneration. The OIG further concluded the arrangement would not constitute grounds for the imposition of civil monetary penalties under a provision prohibiting inducements to beneficiaries.
The vendor, a wholly owned subsidiary of a pharmaceutical manufacturer, has developed technology platforms and services that are designed to help hospitals avoid payment reductions associated with excess readmissions by coordinating care and facilitating patient adherence to discharge plans. Fees for the arrangement will include an initial flat fee; an annual fee, based on patient volume, which can be adjusted and increased only if the actual use exceeds the baseline use already paid for by the annual fee; and additional fees for additional services requested by a hospital.
Services provided by the arrangement include the availability of patient liaisons to monitor a participating patient’s adherence to the hospital discharge plan and his or her current health status. The services also would include scheduling follow-up appointments, the provision of refill reminders, transportation support, and the generation of reports to help the hospitals monitor the use of the services and readmission rates. The vendor certified that neither the vendor nor nurses contracted by the vendor would promote the pharmaceutical manufacturer’s products. In addition, regardless of the patient’s question or symptom, the nurses contracted by the vendor would not refer the patient to any provider or supplier other than the patient’s established providers and suppliers.
The OIG concluded the arrangement posed a low risk of fraud and abuse under the Anti-Kickback Statute because it is unlikely to lead to increased costs or overutilization. The arrangement also is unlikely to interfere with clinical decision-making, OIG concluded. The services would be rendered after a participating patient is diagnosed and discharged from the hospital.
The OIG also concluded that the arrangement is unlikely to result in inappropriate patient steering. Individuals contracted by the vendor to interact with participating patients would be prohibited from referring the patients to any provider, practitioner, or supplier other than a patient’s established provider, practitioner, or supplier.
The full advisory opinion is available online at http://tinyurl.com/oigremote.