Posted by: Robert Markette
April 12, 2006

I have been reading a number of the responses to last weeks OIG opinion regarding a home health agency providing free assessments to potential clients.  Although some people seemed to be surprised by OIG’s opinion, given the repeated responses from OIG whenever a proposal involved anything free being provided to a potential referral source or beneficiary, their response was not really surprising.

The question that has occurred to me is whether OIG’s concern is misplaced.  One of OIG’s repeated concerns in fraud and abuse is over usage of Medicare.  In fact, in numerous opinions, OIG has stated a proposed arrangement is a technical violation, but not one it would choose to enforce, because it was not likely to lead to over utilization.

It strikes me that the arrangement put forward in the opinion OIG issued last week is similar.  The patient is going to receive surgery.  The patient is going to need aftercare.  Medicare is going to pay for this aftercare, regardless of whether the patient receives a free assessment.  If the doctor refers the agency to determine whether the aftercare can occur at home and the beneficiary can receive this assessment for free, why not allow it?

Yes, OIG was right; the agency was most likely willing to provide the free assessment, because the patient, out of familiarity, was more likely to choose that particular provider.  (Hospitals do something similar by opening hospital based home health agencies.  In healthcare, familiarity is a good thing.) 

But isn’t all good marketing designed to ensure that the customer picks your product.  How many attorneys provide free consultations?  It is not a problem for any of them ethically, it is simply good business sense and the individual who may need legal services receives some initial advice from the attorney.

Why can’t a potential home health patient receive the same service?  Perhaps the referring physician need to allow the patient to choose an entity to receive the assessment from or take some other action to prevent “collusion” between providers, but to eliminate the beneficiaries ability to receive the assessment for free is a waste of an opportunity to provide additional services to beneficiaries without incurring any additional costs to Medicare or the beneficiary.

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