The government maintains a very broad definition of “referrals,” which means practices have to work harder than ever to avoid Anti-Kickback law violations. Every time you refer a patient somewhere, you’ve got to have your eye on whether it’s a compliant referral to avoid accusations of wrongdoing.
One way to stay on the straight and narrow is to look for a few common red flags. Ensure that your patient referrals are compliant by mastering these three ways to spot high-risk patient referrals.
1. Clinical Labs Offering Discounts or Paying Unusual Rent Amounts
There are several ways that your practice’s relationship with a referring laboratory can violate the Anti-Kickback Laws, including:
- The lab provides free or discounted goods or services to your practice: This could be a sign that the lab is financially enticing your providers to refer more patients to them.
- The lab pays more than fair market value to the physician: If the lab is paying your providers for anything (from rent to services), the government may assume those payments are enticements.
- The lab sends the provider money on a per-specimen basis: The lab may pay these charges in addition to what the lab collects from the insurer, as a way of “thanking” the provider for the referral.
- The lab pays the referring physician directly, rather than the practice itself: This may suggest that one provider in particular is violating the Anti-Kickback rules.
If you happen to notice any unusual arrangements like these between your providers and referring labs, it’s important to raise a flag with your practice administrator.
2. Telemedicine Companies Urging Providers to Order or Prescribe More
The OIG issued a Special Fraud Alert last year to warn practices that its agents are carefully watching telehealth arrangements so they can spot potential Anti-Kickback violations involving the use of telemedicine. Potential areas to watch include:
- Telemedicine companies paying providers to generate orders or prescriptions: These are often medically unnecessary durable medical equipment, genetic testing, prescription medicines and more.
- Telemedicine companies direct patients to your practice: If the telehealth provider is feeding patients to your practice, that could be problematic.
- The telemedicine firm pays your practice even if the provider never sees the patient in question over telehealth: If you don’t see documentation of an encounter, visit, or service that occurred over telehealth, dig deeper to find out why.
Because telemedicine is still relatively new, providers may not be aware of all the areas that could be classified as fraudulent, so make them aware of these potential violations.
3. Charities That Pay Copays for Patients on Certain Prescriptions
One recent area of focus for the OIG involves patient assistance programs. In these arrangements, pharmaceutical companies will pay a charity. The charity then pays the copayments on behalf of patients who are on the drugs that the pharmaceutical company manufactures.
Any physician who is going to accept fees from a drug or device manufacturer needs to ensure that they’re actually performing services in exchange for the fees and not simply prescribing medications in accordance with patient assistant program arrangements. Any prescriptions must be medically necessary and the provider should not be paid to select particular medications or equipment.
Keep in mind that if you spot an arrangement like this at your practice, it may not necessarily be a violation of the Anti-Kickback Statute, but it’s worth a closer look. Always review any potentially problematic practices to ensure you aren’t in violation of any rules.
Every time you refer a patient to an outside provider, service or facility, you’re at risk of violating the Anti-Kickback Law, but you can better navigate the rules with time-tested tips from compliance expert Lynn Adam, Esq. During her one-hour online training event, Stop Patient Referral Anti-Kickback Violations, Litigation & Penalties, Lynn will walk you through every fact you must know to stay on the right side of the law. Sign up today!
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