I can't find the law for this, so if someone can please help direct me to actual documentation that states it is or is notagainst the law, it would be much appreciated.
Can a home health agency give their Nurses/PT/OT financial bonuses for referring PATIENTS to come on service?
I believe the answer is 100% no. It's illegal and ethically wrong. But I need to see the actual written law before taking this further.
If the nurse is working as a liaison in a hospital and accepts referrals on the agency's behalf, then yes, that's not a problem. At my last job, I was eligible for quarterly bonuses as a liaison and they were based on the number of referrals our area got/the revenue generated from said referrals.
If the nurse is working as a liaison in a hospital and accepts referrals on the agency's behalf, then yes, that's not a problem. At my last job, I was eligible for quarterly bonuses as a liaison and they were based on the number of referrals our area got/the revenue generated from said referrals.
What if the owner of a home health agency offers his employees (nurses) a financial bonus to refer patients to the same home health agency they work for?
Specializes in Nurse Leader specializing in Labor & Delivery.
In what context are these nurses seeing these patients initially when they give the referral? That's what I'm not understanding. How do the nurses know of these potential patients before they become patients?
In what context are these nurses seeing these patients initially when they give the referral? That's what I'm not understanding. How do the nurses know of these potential patients before they become patients?
By referring people they know in the community that have medicare, or patients current family members/neighbors/friends. From what I overhead- They would ask them what their insurance is and if it's medicare, they would have the owner of the company or DON call the patient's primary care physician and say that the patient is requesting home health from the home health agency. Or they would have the patient call their PCP and ask for the referral to home health, and the company being the one that told them about their services. Then the RN would get the bonus.
By referring people they know in the community that have medicare, or patients current family members/neighbors/friends. From what I overhead- They would ask them what their insurance is and if it's medicare, they would have the owner of the company or DON call the patient's primary care physician and say that the patient is requesting home health from the home health agency. Or they would have the patient call their PCP and ask for the referral to home health, and the company being the one that told them about their services. Then the RN would get the bonus.
Do these patients have skilled nursing needs? Medicare only covers home skilled nursing visits under very specific criteria- the patient has to be homebound, for one, the MD has to certify that the patient is homebound and the patient has to have had a face to face encounter with the MD that is directly related to the reason he needs skilled home care. Patients generally can't just "request" home nursing because they want it, they have to have a skilled nursing need. If the patient actually has a skilled nursing need then of course the nurse can refer him to her own agency. In private duty that happens all the time. If the patient doesn't actually have a skilled need, that's fraud.
In what context are these nurses seeing these patients initially when they give the referral? That's what I'm not understanding. How do the nurses know of these potential patients before they become patients?
Amazing the different kinds of people you can meet at the mall. Or in the lobby of a medical building. Probably lots of other places too.
Do these patients have skilled nursing needs? Medicare only covers home skilled nursing visits under very specific criteria- the patient has to be homebound, for one, the MD has to certify that the patient is homebound and the patient has to have had a face to face encounter with the MD that is directly related to the reason he needs skilled home care. Patients generally can't just "request" home nursing because they want it, they have to have a skilled nursing need. If the patient actually has a skilled nursing need then of course the nurse can refer him to her own agency. In private duty that happens all the time. If the patient doesn't actually have a skilled need, that's fraud.
Yes, I understand that. Sure lets assume the patient is home bound, has a skilled nursing need, and has medicare. Is it a violation of the law for an employer (non physician) to give a financial bonus to a employee for referring a patient to the same company (HH Agency) they work for? And a violation to even solicit to the employee's that the employer would give a financial bonus for doing so? And a violation for an employee (LPN/RN/PT/OT) to except this type of bonus for referring the patient to the company they work for? I need to know if this needs to be reported, and if so to whom?
Specializes in Nurse Leader specializing in Labor & Delivery.
Why do people think there are laws for everything?? Lol. Not every aspect of life is legislated.
It's a legitimate question and I don't think it's deserving of derision. The Stark Law prohibits this very activity amongst physicians who have a vested financial interest in whatever they're referring to.
OP, as I already mentioned, I am NOT a lawyer or even a pretend one, but it doesn't appear that there is a law against this. Best thing to do would be call CMS and ask them.
Why do people think there are laws for everything?? Lol. Not every aspect of life is legislated.
Anti-kickback statue states that you can not refer patients for financial gain. If you don't think there is a law or policy for every single thing in nursing then I hope you have malpractice insurance.
Rnasn2017
22 Posts
Thank you NRSKarenRN, I'm going to contact an attorney!