June 08, 2018
The Office of the Inspector General at the HHS recently ruled to allow an equipment sharing arrangement between a federally qualified hospital and a county health clinic, despite the risks for a kickback scenario.
The OIG issued an advisory ruling on the case, which said the office would not take administrative action to stop the arrangement under the Federal anti-kickback statute. The arrangement allows the hospital to purchase telehealth equipment for the county-run clinic, in order to provide HIV consultations.
The arrangement would allow patients seeking preventative care or post-exposure care from the clinic to receive education from the hospital, via the telehealth portal. Telehealth services can be useful in this scenario, given that use of pre-exposure prophylaxis (PrEP) for the prevention of HIV infection must be administered within 72 hours of exposure.
The OIG noted that because of the nature of HIV treatment, the risk for the type of patient steering protected against under the federal anti-kick back statute is low.
“PrEP treatments are limited in scope and are appropriate to prescribe only under limited clinical circumstances, lessening the risk of overutilization,” the OIG wrote. “Increased access to preventative HIV services could reduce the prevalence of HIV and promote public health.”
Distance also played a role in the OIG’s decision. The clinic and the hospital are separated by 80 miles—which would add a burden to patients seeking time-sensitive HIV treatment. Additionally, the hospital’s affiliated pharmacy is 80 miles from the clinic—reducing the likelihood that patients would be steered from the clinic to the hospital’s pharmacy. Also, the hospital does not offer mail order pharmacy services, further decreasing the likelihood of any kickback scenario.
“It seems unlikely that a patient would choose to use the [hospital]’s pharmacy to fill a prescription, given that the [hospital]’s pharmacy is located 80 miles, by car, from the county clinic and does not currently offer mail-order services,” the OIG wrote.
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