The HHS Office of Inspector General has issued an unfavorable advisory opinion finding that a home health agency’s payment to a software vendor for referral management services would violate the Anti-Kickback Statute, according to a June 25 opinion.
Under the arrangement, the requesting home health agency paid a subscription fee to a vendor for software that allows HHAs to electronically receive and accept patient referrals from hospitals during discharge planning. OIG found that the arrangement posed a risk of inappropriate steering and unfair competition, since hospitals often refer patients on a first-come, first-served basis, giving subscribing HHAs a significant advantage over those that don’t pay for the software. The arrangement did not qualify for the safe harbor for referral services because fees were not assessed uniformly across all participants.
OIG also noted the arrangement could create pressure for participating HHAs to bill for medically unnecessary services to recoup subscription costs.
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