HealthCare Marketing and OIG’s Advisory

Author: William Mack Copeland
Healthcare marketing is trending big time in healthcare organizations. The boundless scope of effective marketing certainly helps a healthcare organization flourish in the growing medical industry. Here are certain marketing techniques in vogue among healthcare industries and the dos and don’ts in practicality
1. Grocery Store Gift Cards
Health center’s proposal to offer grocery store gift cards to certain patients in capitated managed care plans as an incentive to receive health screenings or other clinical services. Here the health center would send letters to the enrollees of capitated Medicaid managed care plans. The letters would be sent to all Eligible Enrollees, regardless of the health status, offering the recipient Eligible Enrollee the opportunity to claim an incentive gift card redeemable for $20 in groceries. OIG: “Clearly constitute remuneration to Federal healthcare program beneficiaries and would be of more than nominal value." Not be likely to influence beneficiaries to select the Health Center as their provider because of three reasons 1) The affirmative election process for beneficiaries to obtain reassignment to a different FQHC, 2) The relatively modest value of the proposed gift cards, and 3) The lack of advertising regarding the program.
2. Part-Time Physicians Performing Services as Bona Fide Employees
Physician employees employed to perform professional services; the compensation they receive is for professional services they personally perform. OIG: Since the physicians are bona fide employees, their wages do not constitute prohibited remuneration under the anti-kickback statute.
3. Discounted Ambulance Services
Ambulance company proposed to discount services to nursing home. OIG: Would violate AKS.
4. Sales Commission to manufacturers' representative
Sales agent negotiates contracts on behalf of manufacturer with health systems in return for a commission of a percentage of the invoiced amounts. OIG: Although technically a violation of the AKS, it would not impose penalty since the compensation is at fair market value.
5. Aggressive Marketing by DME Suppliers
Aggressive marketing by DMEPOS supplier including those marketing activities that involve personal contact with beneficiaries is a cause of concern. The following can be extremely coercive, particularly when such activities are targeted at senior citizens, Medicaid beneficiaries, and other particularly vulnerable patients: door-to-door marketing, telephone solicitations, direct mailings, and in-person sales pitches or “informational” sessions. “These activities are highly susceptible to fraud and abuse, as they can lead to over utilization, increased costs to the Federal health care programs and beneficiaries, and inappropriate medical choices, as well as adverse effects on the quality of care patients receive.” Arrangements that offer DMEPOS suppliers opportunities for access to hospital staff and patients are particularly at risk to problematic marketing schemes.
6. Telemarketing by DME Suppliers
Suppliers of DME are prohibited from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in three specific situations:(i) the beneficiary has given written permission to the supplier to make contact by telephone;(ii) the contact is regarding a covered item that the supplier has already furnished the beneficiary; or(iii) the supplier has furnished at least one covered item to the beneficiary during the preceding 15months.
7. Special Fraud Alert
SSA prohibits payment to a supplier that knowingly submits a claim generated pursuant to a prohibited telephone solicitation. Accordingly, such claims for payment are false and violators are potentially subject to criminal, civil, and administrative penalties, including exclusion from Federal health care. Some DME suppliers continue to use independent marketing firms to make unsolicited telephone calls to Medicare beneficiaries to market DME. Suppliers cannot do indirectly that which they are prohibited from doing directly.
8. Special Advisory Bulletin or Contractual Joint Ventures
Hospital expands into a related service line by contracting with an existing provider of that service. Problems: Venture dependent on referrals from hospital’s existing business; hospital neither operates nor commits substantial financial, capital, or human resources to the venture; contractor is an established provider of the same services as the hospital’s new line of business; share in the economic benefit; and payments to the manager/supplier typically vary with the value or volume of business.
9. Gifts to Beneficiaries
Offering valuable gifts to beneficiaries to influence their choice of a Medicare or Medicaid provider is to be suspected. Exceptions: inexpensive gifts (other than cash or cash equivalents) not exceeding $10or $50 in aggregate annually; waivers of cost-sharing amounts based on financial need; properly disclosed copayment differentials in health plans; incentives to promote the delivery of certain preventive care services; any practice permitted under the federal anti-kickback statute pursuant to [the safe harbors]; or waivers of hospital outpatient copayments in excess of the minimum co payment amounts.

Please submit the form

what would you like to do?