Are DMEPOS Suppliers Permitted to Substitute for SNF Discharge Planners and Case Managers?
By:
David S. Barmak, JD CEO
I was recently asked if a Skilled Nursing Facility (SNF) may outsource its discharge planning and case management role to a home care agency in exchange for referring the patient to that home care agency for home care services. The same may be asked of a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier that provides post-operative training in the SNF and assists in the discharge planning and case management process while the patient is still an in-patient at the facility. The short answer is “no.”
It is clear from a Special Fraud Alert published in August of 1995, issued by the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services, the enforcer for the federal government of fraud and abuse issues involving Medicare and Medicaid, that post-acute providers (and by logical extension post-acute suppliers) are not permitted to provide services for discharge planners and case managers that the SNF is supposed to provide through its own discharge planners and case managers. It is clear from the OIG Special Fraud Alert that home care agencies and DMEPOS suppliers are engaging in prohibited kickback activity if they provide a SNF with “discharge planners, home care coordinators, or home care liaisons in order to induce referrals.” It is very likely that this prohibition would also extend to the home care agency and DMEPOS supplier paying a third party, unrelated to the SNF, to provide those services. If the home care agency and DMEPOS supplier were to do this, it would be considered a kickback, namely, them bearing the burden—financial and labor—of relieving discharge planners and case managers of the efforts involved with the discharge process.
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