Beth do you know of an example where this interpretation was applied to a dialysis unit? I think the idea that Medicare puts a ceiling on the care we receive is wrong headed, I understand the theoretical issue the OIG is trying to address but this is not what people on dialysis need. I see a future where there are two dialysis providers and a Medicare ceiling. Uhg…that is not the direction we should be moving.
Dialysis clinics used to pay insurance premiums (usually Medicare supplement) for patients who could not afford to pay these premiums. My clinic did this for a very few patients. However, the Health and Human Services Office of the Inspector General issued a special advisory bulletin on offering gifts and other inducements to beneficiaries. It used the Health Insurance Portability and Accountability Act (HIPAA) as a basis for this opinion and issued it to prohibit inducement to patients to seek treatment at clinics.
In my experience, clinics that paid premiums for their needy patients didn’t advertise that they did this. They wanted patients to pay their own premiums if possible. However, if a patient was too poor to pay a Medicare supplement premium and it would benefit the patient (and the clinic) for the patient to have coverage, the clinic would pay the premium for the patient. In my clinic, the patient wrote the check and my clinic reimbursed the patient for the premium. I know that the Missouri Kidney Program that has an insurance premium benefit asked the OIG for a ruling that allowed it to continue to pay premiums for patients. The American Kidney Fund set up its Health Insurance Premium Program to meet this need for dialysis patients and the OIG advisory specifically mentions their program as being OK. Patients who receive dialysis at clinics that don’t contribute to the program don’t get this help. Clinics must donate enough to cover an administrative fee on top of the premium amount. There can be delays in premium payment. I’ve heard that premium payment delays have led some patients to have their insurance cancelled and social workes have had to advocate for reinstatement. The current process is much more time and labor intensive than the previous way premiums were paid.
I don’t know names of clinics that have refused to purchase for patients educational items over $10, but I have talked with staff that have told me this is the case. An example I can provide is a cookbook that cost over $10. Just in the last week that I talked with a social worker about how the clinic administration (or corporation – I don’t remember which) thought that using their clinic’s emergency fund the way it had historically been used (for late rent, utilities, etc.) might draw OIG ire (and fines). I’m not sure how much of the fear is based on myth and how much is based on reality, but the penalties are too steep for clinics to ignore the OIG’s prohibition when doing anything that might be seen as an inducement.
I wish that more patients and professionals would read the 7 page Special Advisory Bulletin (http://oig.hhs.gov/fraud/docs/alertsandbulletins/SABGiftsandInducements.pdf) and call or write to the Office of the Inspector General with concerns they might have about how this policy has already or might adversely affect patients in their clinics.
Here’s the contact information for the OIG:
By Phone: 202 619-1343
By Fax: 202 260-8512
By E-Mail: paffairs@oig.hhs.gov
By Mail: Office of Inspector General
Office of Public Affairs
Department of Health and Human Services
Room 5541 Cohen Building
330 Independence Avenue, S.W.
Washington, D.C. 20201