The federal Anti-Kickback Statute prohibits offering, paying, requesting or receiving something of value to influence referrals for services paid by federal healthcare programs. For hospice providers, this can affect relationships with physicians, facilities, marketers and other professionals who may refer patients. Here are the key rules to understand.
Paying for Medicare or Medicaid referrals can violate federal law
Paying someone to generate referrals for federally reimbursed hospice services can violate the Anti-Kickback Statute. The law applies when you offer or provide something of value with the intent to influence referrals or generate business covered by a federal healthcare program.
For example, paying a marketer based on the number of Medicare patients referred to your hospice. That could raise serious concerns because the compensation connects directly to the referrals.
A kickback does not have to be a direct cash payment
A kickback can involve anything of value, including gifts, free services, discounts or other benefits offered to influence referrals. You should therefore look beyond direct referral payments when reviewing your business relationships.
For example, providing valuable services to a referral source at no cost. That could create concerns even though you never hand that person money for sending patients to your hospice.
A legitimate business arrangement can still create referral risk
A legitimate business purpose does not eliminate Anti-Kickback concerns when referrals influence the arrangement. You may have a genuine relationship with a physician, facility or marketing company, but the way you structure and compensate that relationship still matters.
An agreement should therefore clearly define the services being provided and the basis for compensation rather than tying payment to the number or value of referrals.
Safe harbors protect only qualifying arrangements
An Anti-Kickback safe harbor protects an arrangement only when you satisfy all of that safe harbor’s requirements. Federal regulations provide protection for certain arrangements, but each safe harbor has specific conditions that the parties must meet.
Failing to fit within a safe harbor does not automatically mean you violated the Anti-Kickback Statute. However, you cannot rely on that safe harbor for protection.
Review referral arrangements before signing
Review compensation, marketing and other referral-related agreements before you enter into them or change their terms. If an arrangement raises questions about referrals or compensation, legal guidance can help you assess the structure before it creates a larger compliance problem. Addressing the issue early can give you more options for fixing the arrangement.