HHS-OIG Issues Unfavorable Advisory Opinion on Pay-to-Play Referral Software Platform Arrangement

Short summary

HHS-OIG ruled that home health agencies' subscription fees for referral management software violate the Anti-Kickback Statute because fees are not uniform and providers gain competitive advantage through payment rather than quality. The arrangement failed safe-harbor test due to variable pricing by geography and location count, risking inappropriate patient steering. Healthcare vendors and operators must restructure fees to be uniform and cost-based only.

• •HHS-OIG advisory opinion No. 26-15 declares referral software subscription fees violate Anti-Kickback Statute safe harbor
• •Non-uniform fees based on geography and location create unfair competitive advantage, steering patients by payment ability rather than care quality
• •Vendors and operators must restructure pricing models to comply; fees must be uniform and reflect actual cost of service delivery only

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