OIG Issues Favorable Advisory Opinion About Online

Health Directories and Advertisements, continued from page 9

$100,000, imprisonment up to 10 years, or both, and a conviction can result in exclusion from Federal health care programs, including Medicare and Medicaid. In addition to potential criminal prosecution, civil monetary penalties (“CMPs”) may be imposed through administrative proceedings.

Under the Beneficiary Inducements Civil Monetary Penalty provision, any person who offers or transfers remuneration to a Medicare or Medicaid beneficiary that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner or supplier for the order or receipt of any item or service for which payment is made, in whole or in part, by Medicare or Medicaid may be subject to the imposition of CMPs. Remuneration under this statute is the “transfer of items or services for free or for other

Updates in Chron-

ease, continued from page 14 clude trials attempting to gain further insight into emphysema progression or muscle wasting, cutting edge bronchoscopic interventions to reduce mucous production and improve airway obstruction, disease phenotyping using novel diagnostic imaging modalities, and behavioral interventions. Exciting treatments in the pipeline include AIRFLOW-3, which is investigating the use of targeted bronchoscopic lung denervation to improve airflow obstruction and reduce exacerbation risk, Ensifentrine, a novel drug targeting inflammatory pathways to alleviate symptoms and reduce healthcare utilization, and Dupilumab, which recently demonstrated tremendous benefit in exacerbation reduction and quality of life improvement. In addition to cutting-edge basic science and clinical COPD research, UAB also has a Southeast Institute for Innovation in Palliative and Supportive Care, and we are actively conducting research on geriatrics and palliative care in COPD to help patients age successfully in their communities and improve quality of life for patients and their families. than fair market value.”

Dr. Iyer and Dr. Wade are pulmonologists at the UAB Division of Pulmonary, Allergy, and Critical Care Medicine and the UAB Lung Health Center. Their clinical interests and research focus are on COPD. Dr. Iyer also directs clinical pulmonary services for Cooper Green Mercy Health Services Authority. Inquiries about UAB Lung Health Center studies or referrals can be emailed to lunghealth@uabmc. edu or call to (205) 934-5555.

The OIG determined that Requestor’s arrangement implicated the Federal Anti-Kickback Statute based on the following three facts: (1) Providers pay the Requestor to recommend them to Federal health care program beneficiaries;

(2) Providers pay the Requestor to “arrange” for the provision of items and services through the appointment-booking feature of the website; and (3) Requestor provides remuneration to Users in the form of free use of the website which may lead to the User purchasing items or services reimbursable by a Federal health care program. Although the OIG determined that the arrangement implicated the Federal Anti-Kickback Statute (and no safe harbor applied), it performed an analysis based on the “totality of the circumstances” to determine whether it would impose sanctions. Those factors include: (1) amount and structure of compensation; (2) identity of the party engaged in the advertising and relationship to the target audience; (3) nature of the marketing activity; (4) item or service being marketed; (5) the target population; and (6) any safeguards to prevent abuse. Through this analysis, the OIG determined that the risk of fraud and abuse was sufficiently low, allowing OIG to issue a favorable opinion and state that it would not impose sanctions.

Similarly, under the Beneficiary Inducement CMP analysis, the OIG concluded that the free use of the website to Federal health care program beneficiaries could influence a User to select a Provider that would render services reimbursable by a Federal health care program, which would make the Requestor subject to potential CMPs. However, the OIG states in the opinion that it would exercise “its discretion” and not impose sanctions in connection with the described arrangement.

As with all OIG Advisory Opinions, the Opinion states that it cannot be relied upon by any other person other than the Requestor. That being said, health care providers should be cautious of paying for referrals of any sort, including paying for listings on websites that might drive patients to make appointments or advertising.

The full opinion can be found at https://oig.hhs.gov/documents/advisoryopinions/1127/AO-23-04.pdf

Angie C. Smith is a Partner at Burr & Forman LLP practicing exclusively in the firm’s Health Care Practice Group. Angie may be reached at (205) 458-5209 or acsmith@burr.com.

Management must learn the technology in order to hold staff accountable and troubleshoot problem areas. When you grow your staff in their knowledge, you are investing in the person, and they know it. They stay engaged that way and can help you work out problems.”

The managers of each department dealing with reimbursements, including front desk and clinical, need to meet to review month-end reports to assure any technology issues, staffing problems, and trends are resolved moving forward.

“Look at the key performance indicators and brainstorm on how they are different from last year at this time, as well as last month,” Lunceford says, “because the doctors are going to have questions. Know what answers you are going to give. Make sure you have a plan.”

Personnel are becoming more expensive, not just to find, but to keep. Re- continued from page 7 cent salary survey results for Alabama show a 10 percent increase in pay on average over the last two years for front desk personnel, billers, and coders. “It only makes sense,” Lunceford says, “to keep staff trained, efficient, and knowledgeable enough to work the clients and get the money produced.”

37 YEARS STRONG