Tag: Todd Moody
Legal: Tread lightly with telehealth prescriptions
April 23, 2018Todd Moody
A. There is a good chance the prescription issued will not be valid, and the payment for the telehealth encounter could be problematic under an anti-kickback statute. In order for a prescribing practitioner, such as a physician, physician assistant, or nurse practitioner, to issue a valid prescription, the practitioner must first establish a practitioner-patient relationship. Most states now allow a practitioner to establish this relationship by way of a telehealth...
Legal: Don't run afoul of statute
April 23, 2018Todd Moody
A. It depends on how the item will be paid for and where the patient lives, but for most patients this would not be acceptable.The Federal Anti-Kickback Statute (AKS) prohibits a supplier from giving a person something of value to induce the person to purchase an item covered by a federal health care program. Most states have similar laws, and some states have an AKS that applies regardless of how the item is being paid for (e.g., Medicaid, commercial insurance, cash). Paying for the cost of...
Legal: Don't violate payer contracts
February 27, 2018Todd Moody
A. This is probably not a good idea.First, it is important to note that the other supplier's payer contract likely has provisions related to subcontracting that either prohibit the supplier from subcontracting out functions under the contract or requiring the supplier to get permission from the payer before subcontracting. So the arrangement could violate the terms of the payer contract.Second, even if the payer contract is silent about subcontracting, if the arrangement consists of the non-contracted...
Legal: Mind the threshold
January 25, 2018Todd Moody
A. Yes, but the appropriate payment terms will depend on the nature of the leads.When reviewing any lead generation arrangement, a key regulatory issue is whether the arrangement complies with the federal Anti-Kickback Statute (AKS). The AKS prohibits a person from soliciting, receiving, offering, or paying anything of value in return for, or in order to induce referrals or the arrangement of referrals of individuals covered by a federal health care program (FHCP).In light of this, a threshold...