Are you thinking of offering a free introductory visit? First consider the regulations and the rulings of the Office of the Inspector General (OIG). The OIG posted an advisory opinion allowing free introductory visits by home health agencies. [Download PDF: OIG Advisory Opinion Allowing Free Home Health Introductory Visits] However, before home health agencies interpret this as a green light for free marketing visits, the specifics of this opinion should be reviewed closely. This opinion is significant in that free introductory visits are a common marketing offer in physical therapy, home health, and home care. The problem is that for providers participating in federal programs such as Medicare and Medicaid, the law seems to prohibit free visits. Indeed, highly publicized aggressive enforcement of anti-kickback statutes resulting in hundreds of millions of dollars in fines have included such infractions.

Specifically, section 1128 of the Social Security Act prohibits offering anything of value to induce or reward referrals. Additionally, healthcare providers may not offer patients anything that may influence their selection of a healthcare provider. Add to this separate regulations that demand Medicare and Medicaid receive the best prices and values that the provider offers, and you end up with a situation where healthcare providers cannot even offer valuable inducements or discounts to clients paying privately. The Affordable Care Act has created pressure on the OIG and elbow room for the OIG to reverse some of their interpretations so Medicare and Medicaid beneficiaries can avail themselves of more benefit plans and lower service costs, but the OIG has not moved quickly in this regard. It’s noteworthy that the OIG has previously taken the opinion that incentives of nominal value (no more than $10 per gift and $50 per year) are not prohibited by section 1128 of the Social Security Act, but many home health providers are justifiably cautious of this exception because 1128 is not the only anti-kickback law affecting home health. Penalties can be stiff and may include revocation of a home health agency’s ability to participate with federal programs such as Medicare and Medicaid.

With all that being the case, how is the OIG now allowing free introductory visits? In their advisory opinion posted August 2015, they lay out some very specific conditions. One thing to keep in mind about this OIG advisory opinion is that it is only for the specific home health agency that requested the opinion, but don’t over-interpret that. The vast majority of OIG advisory opinions state they are only for the requestor; the OIG attempts to enforce the law equally; and these advisory opinions give us specific, practical insight into the OIG’s legal interpretations. Here are the relevant details of the specific free introductory home health visit program approved in this OIG advisory opinion:

  • At the point the patient accepts and receives the free introductory home health visit, the patient had already selected the home health agency from a list. The agency had no contact with the patient prior to that selection.
  • The free visit includes no diagnostic or treatment services. The free visit could be conducted by a person with no clinical training.

The background information in the advisory opinion mentions some other interesting details of the approved program, but the advisory opinion is unclear as to how important these details are in the approval of the free introductory visit program. For instance, the opinion states that the visits would not otherwise be billable to federal programs due to their non-clinical nature. The background information also includes the detail that the healthcare provider is not including the costs of these visits in their cost reports or in any other way shifting the burden of these costs to any federal health care program, other payors, or patients.

The big message is that free introductory visits may be permissible as program features for Medicare and Medicaid-certified home health agencies, but still within a minefield of seemingly self-contradictory and dangerous regulations. More home health agencies and associations should seek OIG advisory opinions on this issue to further clarify real world situations that will be of value to home health. Most home health agencies have available to them proven-effective, safe, and legal marketing strategies they have not fully explored, so the risk-to-benefit ratio of free introductory visits is still suspect.


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