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 Oig Closes Off Proposed ESRD Safe Harbor  

In a Dec. 9 Federal Register notice, the HHS Office of Inspector General withdrew a proposed safe harbor to the anti-kickback statute that would have allowed independent dialysis centers to pay Part B and Medigap premiums for financially needy ESRD patients. The proposal – released back in May 2000 – would have offered safe harbor protection only if facilities refrained from advertising premium payments, didn’t make payment of beneficiary premiums a routine practice, and made goodfaith efforts to ensure that premium recipients were financially needy.

Ultimately, however, after poring over public comments, the OIG decided that even with the limitations built into the proposal, a safe harbor for ESRD premium supports would still pose too many risks. “The direct payment of supplemental premiums by ESRD providers for financially needy patients carries the same potential for fraud and abuse as the provision of free or below market rate goods or services by any other health care provider,” the OIG avers. “In short, the exception would promote the very conduct the statute prohibits: the offering of remuneration to influence the selection of a provider.”

The OIG also worried about the effects of adverse selection on insurers, since the safe harbor could open the way for the enrollment of large numbers of very sick patients. To see the withdrawal notice, go to


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