Marketing your home health or hospice agency can be tricky. You might worry about accidentally crossing legal boundaries. Or maybe you’re concerned about risking fines, or damaging your reputation. With a sea of regulations and vague guidelines, it's no surprise many agency owners feel overwhelmed. But don’t let fear paralyze your marketing efforts—this guide is here to help.
At The Home Health Consultant, we bring over 20 years of experience helping home health and hospice agencies maintain compliance. Believe it or not, ethical marketing is a core component of keeping your agency compliant. Our expertise goes beyond operational processes—it extends into marketing regulations as well.
We’ll break down the relevant laws, explain how they apply to your marketing strategies, and help you avoid common pitfalls. From the Anti-Kickback Statute to ACHC standards, you’ll gain a clear understanding of compliant marketing. Walk away ready to promote your agency with confidence.
The Four Laws or Regulations that Affect Home Health or Hospice Marketing
Before launching any marketing campaign, understanding these four laws is crucial:
- The Anti-Kickback Statute (AKS)
- The Stark Law
- The Beneficiary Inducement Law
- ACHC Conflict of Interest Requirements
- ACHC Marketing Regulations
These regulations are designed to prevent fraud, protect patients, and ensure a fair healthcare system. Let’s dive into each one.
How Does the Anti-Kickback Statute Work for Home Health & Hospice Agencies?
The Anti-Kickback Statute (AKS) prohibits offering or receiving anything of value in exchange for patient referrals involving federally funded programs like Medicare. This means no cash incentives for referrals. It also means no arrangements where referrals create financial gain for either party.
For example, let’s say your agency has a relationship with a local physician’s office. If you were to offer the physician $50 for every patient they refer to your agency, this would directly violate the AKS. If you provide free office supplies to encourage them to send patients your way, this would also violate the AKS. Both the person offering and the person accepting the kickback would face liability.
Violating the AKS carries serious penalties, including steep fines and potential jail time. To stay compliant, avoid financial ties with referral sources and regularly train staff on AKS regulations.
Hospice agencies should be cautious with the AKS, as compliance can be complex. Many medical directors at hospice agencies also work at other healthcare facilities. To avoid a situation where referrals from your medical director could be in violation of the AKS, there are a few things you should do:
- Payments to Medical Directors must reflect fair market value
- Clear records must show both the services provided and that the pay aligns with industry standards.
This information was sourced from an article by Reinhart Law Firm. For a more comprehensive analysis, we encourage you to explore their detailed insights on the topic. When in doubt, always seek guidance from legal counsel.
How Does the Stark Law Work for Home Health & Hospice Agencies?
The Stark Law, also known as the Physician Self-Referral Law, prevents physicians from referring patients to services provided by entities they have a financial relationship with. This law is strict, meaning even unintentional violations can lead to penalties.
For example, if a physician refers a patient to a home health agency they partially own, this would be a direct violation. Similarly, an agency cannot bill Medicare or Medicaid for services linked to self-referrals. To comply, agencies should audit physician relationships regularly. You can also develop internal processes to monitor for financial conflicts of interest.
You may be wondering how the stark law law applies in hospice agencies. In hospice, Medical Directors are often direct employees of the hospice agency, but can also refer patients and certify terminal illness. This practice is perfectly acceptable in hospice, as long as the Medical Director is not a shareholder of the hospice, and does not get paid for the referral. However, you should be aware of how hospice medical referrals interact with the anti-kickback law as mentioned above.
How Does the Beneficiary Inducement Law Work for Home Health & Hospice Agencies?
The Beneficiary Inducement Law prohibits offering anything of value to Medicare or Medicaid patients to influence their choice of providers. This includes gifts, incentives, or other benefits meant to sway patient decisions.
However, there’s an important nuance: nominal gifts are allowed. Why? Because CMS recognizes that strengthening beneficiary engagement can improve the healthcare system. For example, a nurse visiting a patient regularly—two or three times a week, or even weekly—may want to acknowledge the holidays with a small token. This could be a Starbucks gift card or a box of chocolates. That’s perfectly acceptable.
Allowing these small gestures fosters genuine human connection, which is at the heart of healthcare. Compassion and caring for others are integral to patient care. This exception enables agencies to maintain that personal touch without crossing into prohibited kickbacks or unethical incentives.
If you want to give gifts for a patient’s birthday, the holidays, or any special occasion, ensure the value doesn’t exceed $15 per item AND $75 annually per patient. Staying within these limits is key to compliance with Medicare’s rules.
Does ACHC Have Any Regulations About Marketing My Agency?
The Accreditation Commission for Health Care (ACHC) requires agencies to maintain ethical and transparent marketing practices. There are two standards to be aware of:
- HH1-4A.01
- HH2-1A.01
ACHC Standard HH1-4A.01 and How It Relates to Referral Sources
The ACHC standard that covers referral sources reads, “Any conflict of interest has been properly disclosed.” This makes it essential for agencies to carefully evaluate relationships with referral sources.
For example, if a physician refers patients to an agency where their direct family member works—such as a sibling, parent, or child—this could be a compliance issue.
The level of concern depends on factors like the number of referrals and the agency's relationship with the physician. If the physician is the spouse of the agency owner or an employee, it could resemble a self-referral, which may not be favorably viewed.
Marketing relationships can sometimes fall into gray areas, making it crucial to use sound judgment. Agencies must tread lightly to ensure they don't inadvertently violate compliance rules. Always assess relationships thoroughly and avoid actions that could jeopardize the agency's integrity.
ACHC Standard HH2-1A.01 and How It Relates to Marketing Your Agency
Another ACHC standard addressing marketing is HH2-1A.01. The standard states, “Marketing materials are current and accurately reflect the care/services required.”
To meet these standards, agencies must actively monitor their marketing efforts. Examples of how to do this include:
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Training staff on ACHC marketing regulations
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Updating all forms and materials when any contact information changes
What Happens If I Break Laws or Regulations Regarding Referrals and Marketing?
Breaking these laws can lead to serious consequences. Financial penalties under the AKS can reach six figures per violation. Failing to comply with ACHC standards may jeopardize your accreditation. Even more damaging is the potential loss of trust from patients and referral sources, which can harm your reputation and bottom line.
If an ACHC violation occurs, swift action is critical. Stop the questionable practice immediately and work with a compliance consultant to understand the scope of the violation and necessary next steps.
If you’re in violation of any federal laws, seeking legal counsel will be your best course of action. While these are steps we recommend, your approach to any marketing violations should be evaluated on a case-by-case basis to best suit what your agency needs most.
How to Successfully Market Your Home Health or Hospice Agency
Marketing your home health or hospice agency doesn’t have to feel like navigating a minefield. With a strong understanding of federal laws and ACHC standards, you can create ethical and effective marketing strategies.
If you’re unsure about specific practices, don’t hesitate to consult with experts. Your reputation, accreditation, and bottom line depend on getting this right. To find out more about how to market your agency and get more referrals, read our article on How to Effectively Brand and Market Your Home Health or Hospice Agency.
For agencies that want to dive deeper, ACHC also offers a five-part course on mastering home health marketing.
*This article was written in consultation with Mariam Treystman.
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