A new unfavorable advisory opinion from the Office of Inspector General (OIG) is taking issue with a subscription-based referral program that appears to reward agencies that pay a software vendor for the capability to respond electronically.
The OIG Advisory Opinion 26-15 was issued in response to an arrangement that involved a subscription service to a software vendor that connects hospitals to home health agencies when referring patients in the course of discharge planning.
According to the opinion, agencies are expected to pay for a subscription so that they can electronically respond to the hospital’s referrals. In its response, the OIG was primarily concerned about the challenges a provider would face if they were not a subscriber.
“Agencies with the ability to electronically receive and respond to referral requests through the software would have a significant competitive advantage over non-paying agencies,” the OIG wrote. “Consequently, it appears that agencies paying the vendor fees would get patients because they paid for the opportunity rather than on the basis of the quality of care they offer.”
The OIG concluded the arrangement would generate prohibited remuneration under the federal anti-kickback statutes if the requisite intent were present. The opinion has no applicability beyond the arrangement presented.