The healthcare industry is under constant political pressure due to its necessity, costs, and the fair amount of corruption within the system. To eliminate some corruption within the healthcare industry, the federal government enacted the Anti-Kickback Statute in 1972.
As the name implies, the Anti-Kickback Statute prohibits people or businesses from offering healthcare workers money–or anything else of value–in exchange for patient referrals to federal medical programs. Since Medicare is a federal medical program, this statute is significant for home health care providers.
The United States v. Patel Case
The Anti-Kickback Statute has gone through a number of revisions from court rulings and the redefinition of some terms. The most recent change occurred on February 10, 2015, when in the United States v. Patel, the term referral was redefined.
Dr. Kamal Patel was found guilty of accepting kickbacks for referring patients to Chicago-based home care agency Grand Home Care. The evidence showed that Patel had received $31,900 from Grand Home Care, in $400 and $300 increments, for patient admissions and recertifications, respectively.
Patel argued that the common usage of the term referral was to refer a patient to a specific doctor or other healthcare provider, not a whole company. He also added that he wasn’t making referrals in return for kickbacks, but that Grand Home Care was offering money in return for referrals–a slight but significant difference.
The difference was not great enough to convince the court, however, and they found Patel guilty. This case set a precedent for the redefinition of referral to include not just providers, but home care companies and other health service companies as well.
What This Means for Home Health Providers
The biggest lesson home health providers should learn from the United States v. Patel case is that they need to be extremely cautious when offering (or accepting) anything of value to any company or individual with whom they have direct business relationships. Even gifts around the holidays can sometimes be viewed as a bribe, depending on the value. Obviously a fruit basket probably won’t get you jail time, but it’s best to go by the book when it comes to business relationships.
All employees and representatives of home health providers also need to be aware of personal ties that could be considered conflicts of interest. Many people get ahead in their careers by making connections. However, if anything of value is exchanged in order to make those connections, it can lead to possible violations of the Anti-Kickback Statute.
It is important for all health care service providers to stay abreast about changes in health care laws. Accepting or giving a referral fee might be something home health providers consider customary, when in reality it’s illegal. The old Latin phrase applies: “Ignorantia juris non excusat” or “Ignorance of the law is no excuse.”