OIG: No free in-home CHF tests

Sunday, August 5, 2007

WASHINGTON – A durable medical equipment provider’s proposal to offer patients free in-home congestive heart failure assessments could violate the anti-kickback statute, the Office of Inspector General (OIG) stated in an opinion posted July 30.

The OIG concluded that the assessments constitute “more than nominal” remuneration. The legal threshold is $10, and the tests are valued at $22 each.

The provider, whose name was redacted, requested the opinion.

Per the proposal, the provider would offer patients diagnosed with CHF free in-home assessments with oximetry testing. The assessment would include a subjective functional assessment and numerous measurements. Additionally, the patient would receive education. The provider would publicize the program through sales and marketing efforts directed toward physicians and their staffs.

Even though some Medicaid programs cover oximetries performed by oxygen providers, the provider indicated that it would not seek Medicare reimbursement for the tests. Medicare rules state that independent diagnostic testing facilities (IDTFs) must perform the tests.

The OIG also concluded that the proposal would likely influence beneficiaries to select the provider for oxygen and/or other Medicare-payable goods and services.