Medicare program integrity manual sleep clinics

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If a business arrangement clearly falls within a safe harbor, then it does not violate the anti-kickback statute. In the preamble to the regulations implementing this provision, the O stated that the statute does not prohibit the giving of incentives that are of “nominal value.” The O defines “nominal value” as no more than $10 per item or $50 in the aggregate to any one beneficiary on an annual basis. State requirements and prohibitions vary from state to state.

Medicare Program Integrity Manual, Chapter 13 - YEI Healthcare

If the arrangement does not clearly fall within a safe harbor, then it must be examined in lht of the anti-kickback statute and related court decisions to determine if it violates the statute. “Nominal value” is based on the retail purchase price of the item. Some state statutes refer to definitions and standards found in the federal statutes while others are materially different.

Supplier <i>Manual</i>, Chapter 4 CMNs - CGS <i>Medicare</i>

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To be successful in its marketing and joint venture efforts, an HME supplier needs to “think outside the box,” but also needs to understand the legal restrictions that apply to Medicare-enrolled suppliers. O Special Fraud Alerts and Special Advisory Bulletins From time to time, the O publishes Special Fraud Alerts and Special Advisory Bulletins that discuss business arrangements that the O believes may be abusive, and educate health care providers concerning fraudulent or abusive practices that the O has observed and is observing in the industry.Of the various safe harbors, some that are particularly pertinent to HME suppliers include safe harbors for equipment rental, space rental, employees, and personal services and management contracts. Some state statutes apply only when the payor is a state health care program, while other statutes apply regardless of the identity of the payor.

Supplier Manual, Chapter 4 CMNs - CGS Medicare

It’s easy to be caught off guard, as such restrictions often do not apply to other industries, and practices that are common in other industries are prohibited in the health care industry. § 1320a-7b) It is a felony for a person or entity to knowingly or willfully solicit or receive any remuneration in return for referring an individual for the furnishing or arranging for the furnishing of any item for which payment may be made under a federal health care program, or in return for purchasing, leasing or arranging for or recommending the purchasing or leasing of any item for which payment may be made under federal health care programs. These documents reflect the O's opinions regarding the application of the fraud and laws.


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