Policy Manual sample

MDT Home Health Care Agency, Inc. The Anti-Kickback Statute, 42 U.S.C.&1320a -7b(b), prohibits offering, soliciting, paying, or receiving remuneration for referrals for services that are paid in whole or in part by the Medicare Program. In addition, the statute prohibits offering, soliciting, paying, or receiving remuneration in return for purchasing, leasing, ordering, arranging for, or recommending the purchase, lease, or order of any goods, facility, item, or service for which payment may be made in whole or part by the Medicare Program. An arrangement will be deemed to not violate the Anti-Kickback Statute if it fully complies with the terms of a safe harbor issued by the OIG. Arrangements that do not fit within a safe harbor and thus do not qualify for automatic protection may or may not violate the Anti-Kickback Statute, depending on their facts. The Stark Statute, 42 U.S.C.&1395nn,prohibits a physician from making a referral for certain designated health services to an entity in which the physician (or a member of his or her family) has an ownership/investment interest or with which he or she has a compensation arrangement, unless an exception applies. Exceptions to the prohibition on self referrals can be found in the Code of Federal Regulations at CFR411.355-357. To access the Code of Federal Regulations, visit www.gpoaccess.gov/cfr/index.html on the Web. Designated health services in which self-referral is prohibited include the following: * Clinical laboratory services; * Physical therapy services; * Occupational therapy services; * Speech-language pathology services; * Radiology and certain other imaging services such as magnetic resonance imaging and ultrasound; * Radiation therapy services and supplies. * Durable medical equipment (DME) and supplies; * Parenteral and enteral nutrients, equipment, and supplies; * Prosthetics, orthotics, and prosthetic devices and supplies; * Home health services and supplies; * Outpatient prescription drugs; and * Inpatient and outpatient hospital services. Home Health Agency Policies A-143