What’s New on Readmission Corner

HCAF would like to thank our Associate Member, Myla R. Reizen of Jones Walker LLP for submitting this series.

There have been many new developments on the readmissions front over the past several months. This is the third part in a four part series in which we highlight some available information concerning readmissions.

Advisory Opinion Related to Reducing Preventable Readmissions

On August 9, 2013, the Office of Inspector General (OIG) issued an advisory opinion regarding an entity’s proposal to contract with hospitals to provide services to patients with certain diagnoses following hospital discharge with the goal of reducing preventable hospital readmissions (the “Proposed Arrangement”).

In this Proposed Arrangement, the vendor is a wholly owned subsidiary of a major pharmaceutical manufacturer. The vendor’s mission is to “develop technology platforms and services that will better coordinate care, help patients adhere to their discharge plans, and avoid preventable hospital readmissions.” The services offered through the Proposed Arrangement would be available to patients who were hospitalized with one of the conditions that are part of the Hospital Readmission Reduction Program. The Proposed Arrangement would include a number of services, such as a Patient Liaison, 24-hour nurse hotline, and generation of reports to monitor the use of services. The Proposed Arrangement would include three different fees.

The OIG analyzed the Proposed Arrangement under both the Anti-kickback Statute and the Civil Monetary Penalties Law (“CMPL”). Based on the specific facts and circumstances of this Proposed Arrangement, the OIG concluded that the Proposed Arrangement would pose a low risk of fraud and abuse under the Anti-kickback Statute. In general, it stated, the Proposed Arrangement would not lead to increased costs or overutilization, be unlikely to interfere with clinical decision making, be unlikely to result in inappropriate patient steering and would have a number of safeguards. OIG issued a favorable opinion with respect to the CMPL analysis as well for different reasons.

The OIG provides its standard limitations to this letter; one limitation being that the advisory opinion is issued only to the requestor of this opinion. The OIG states that “this advisory opinion has no application to, and cannot be relied upon by, any other individual or entity.”

This newsletter should not be construed as legal advice or a legal opinion on any specific facts or circumstances. The contents are intended for general informational purposes only, and you are urged to consult your own attorney concerning your own situation and any specific legal questions you may have.Please let us know if you have any questions concerning this article or readmissions in general.


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