What Can Providers Give to Patients?

Providers, including marketers, are tempted to give patients and potential patients free items and services. While providers usually have good intentions, they must comply with applicable requirements. As Part 1 of this series indicates, there are two applicable federal statutes: the anti-kickback statute (AKS) and the civil monetary penalties law (CMPL). Part 1 also makes it clear that there are a number of exceptions or “safe harbors. If providers can meet the requirements of an applicable safe harbor or exception, they can give patients and potential patients free items and services that would otherwise violate applicable requirements. 

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, announced that; effective on December 7, 2016; the limits on free items and services given to beneficiaries increased. Specifically, according to the OIG, items and services of nominal value may be given to patients or potential patients that have a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis. The previous limits were $10 per item or $50 in the aggregate per patient on an annual basis.

Under section 1128A(a)(5) of the Social Security Act, persons who offer or transfer to Medicare and/or Medicaid beneficiaries any remuneration that they know or should know is likely to influence beneficiaries’ selection of particular providers or suppliers of items or services payable by the Medicare or Medicaid Programs may be liable for civil money penalties for up to $10,000 for each wrongful act. “Remuneration” includes waivers of copayments and deductibles, and transfers of items or services for free or for other than fair market value. 

In the Conference Committee report that accompanied the enactment of these requirements, Congress expressed a clear intent to permit inexpensive gifts of nominal value given by providers to beneficiaries. In 2000, the OIG initially interpreted “inexpensive” or “nominal value” to mean a retail value of no more than $10 per item or $50 in the aggregate per patient an annual basis. 

The OIG also expressed a willingness to periodically review these limits and adjust them based on inflation. Consequently, effective on December 7, 2016, the OIG increased the limits of items and services of nominal value that may be given by providers and suppliers to beneficiaries to a retail value of no more than $15 per item or $75 in the aggregate per patient on an annual basis. Providers may not, however, give cash or cash equivalents. 

These amounts may still seem paltry to many providers. According to the OIG, providers who see that patients need items worth more than these limits should establish relationships with charitable organizations that can provide items and/or services that are not subject to these limits. In other words, work together to meet the needs of patients!

©2021 Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author. [Articles Shared by HHAC with Permission from the Author]  

Home Health Providers Likely to Play ‘Very Important Role’ in Direct Contracting

Home Health Care News

Direct contracting is quickly becoming one of the most prominent examples of the overall shift to value-based care. And home health providers will likely play a critical role in the payment model’s success.

Although the Center for Medicare & Medicaid Innovation (CMMI) paused certain direct-contracting options when the new administration took over, it remains an area that forward-thinking home-based care companies are pursuing.

“Home health care has a tremendous track record of being effective and efficient,” Michael Barret, the VP of direct contracting for Collaborative Health Systems, told Home Health Care News. “Every system can’t afford to put clinicians moving through the community at the scale that needs to happen. I think home health has a unique asset base.”

Read Full Article 

Infrastructure Negotiations Continue in Fits and Starts

National Council of NonProfits

The release of the President’s budget proposals did not divert attention away from the main policy action in Washington: bipartisan negotiations between Republican Senators and the White House over significant legislation to fund infrastructure and other projects and programs over the next five to eight years. The results of these negotiations are of great importance to charitable nonprofits for two reasons: first, the substantive details in any legislative package, and second, whether policymakers take the bipartisan path or the partisan path on the President’s top agenda item will determine which, if any, of the nonprofit policy priorities can be attached and enacted this year. Further, how any infrastructure bill will be financed could affect other nonprofit priorities.

In late March, President Biden offered the $2.2 trillion American Jobs Plan as his initial set of infrastructure proposals. A group of Republican Senators countered with a $568 billion package dealing only with roads, bridges, waterways, and broadband – items they consider “true” infrastructure matters. The White House then released a $1.7 billion counteroffer that the Republicans rejected and put forth their counteroffer last week. Called the Republican Roadmap, the Senators upped their proposal to $928 billion in spending on infrastructure, about $250 billion of that amount deemed new spending (above what’s already expected by extending current law). The plan one-pager claims, “This counteroffer delivers on much of what President Biden provided in his feedback to us during our Oval Office meeting while still focusing on core infrastructure investments.”

Paying for It: Regardless of what the two sides agree to spend, the answer to how to pay for it could create significant challenges. Politico summarized the standoff this way: “The White House has suggested paying for the package by increasing the corporate tax rate, a non-starter for the GOP. Republicans have instead suggested user fees and using unused money allocated for coronavirus relief, arguing that there is a precedent for doing so. Democrats have rejected those suggestions.” In a separate memo to the President, the Senators suggest partially paying for the legislation by tapping unspent federal relief funds sent to the states. That latter proposal – reclaiming or “clawing back” monies approved in the American Rescue Plan Act – is strongly opposed by state and local governments, and by nonprofits.

Exclusive: U.S. to give ransomware hacks similar priority as terrorism

Christopher Bing / www.reuters.com  

The U.S. Department of Justice is elevating investigations of ransomware attacks to a similar priority as terrorism in the wake of the Colonial Pipeline hack and mounting damage caused by cyber criminals, a senior department official told Reuters.

Internal guidance sent [last] Thursday to U.S. attorney's offices across the country said information about ransomware investigations in the field should be centrally coordinated with a recently created task force in Washington...

Last month, a cyber criminal group that the U.S. authorities said operates from Russia, penetrated the pipeline operator on the U.S. East Coast, locking its systems and demanding a ransom. The hack caused a shutdown lasting several days, led to a spike in gas prices, panic buying and localized fuel shortages in the southeast. read more

Colonial Pipeline decided to pay the hackers who invaded their systems nearly $5 million to regain access, the company said.

The DOJ guidance specifically refers to Colonial as an example of the "growing threat that ransomware and digital extortion pose to the nation."

"To ensure we can make necessary connections across national and global cases and investigations, and to allow us to develop a comprehensive picture of the national and economic security threats we face, we must enhance and centralize our internal tracking," said the guidance seen by Reuters and previously unreported.

Read Full Article