{"id":9735,"date":"2026-01-23T03:03:42","date_gmt":"2026-01-23T03:03:42","guid":{"rendered":"https:\/\/usatrustedlawyers.com\/blog\/oig-reels-in-the-employment-safe-harbor-recent-advisory-opinion-signals-risks-for-sign-on-bonuses-in-home-care-polsinelli\/"},"modified":"2026-01-23T03:03:42","modified_gmt":"2026-01-23T03:03:42","slug":"oig-reels-in-the-employment-safe-harbor-recent-advisory-opinion-signals-risks-for-sign-on-bonuses-in-home-care-polsinelli","status":"publish","type":"post","link":"https:\/\/usatrustedlawyers.com\/blog\/oig-reels-in-the-employment-safe-harbor-recent-advisory-opinion-signals-risks-for-sign-on-bonuses-in-home-care-polsinelli\/","title":{"rendered":"OIG Reels in the Employment Safe Harbor: Recent Advisory Opinion Signals Risks for Sign-On Bonuses in Home Care | Polsinelli"},"content":{"rendered":"\n<div id=\"html-view-content\">\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Key Takeaways:<\/span><\/span><\/h2>\n<ul>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">In a rare unfavorable advisory opinion, OIG concluded that certain sign-on bonuses for home care workers are a risk under the federal Anti-Kickback Statute, despite historical reliance on the Employment Safe Harbor.<\/span><\/span><\/li>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Home care providers who rely on sign-on or other recruitment bonuses to attract family caregivers should evaluate their current practices to ensure they remain compliant.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Some home care agencies use sign-on bonuses and other upfront incentives to remain competitive in the face of staffing shortages. In <\/span><\/span><a href=\"https:\/\/oig.hhs.gov\/documents\/advisory-opinions\/11440\/AO-25-12.pdf\" rel=\"nofollow noopener\" target=\"_blank\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Advisory Opinion No. 25-12<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">, issued December 30, 2025, OIG declined to approve a home care agency\u2019s proposed sign-on bonus program for family caregivers or attendants, concluding that the arrangement would pose a substantial risk under the AKS and the civil prohibition on beneficiary inducement (Beneficiary Inducements CMP).<\/span><\/span><a href=\"#_ftn1\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"><sup>1<\/sup><\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> This opinion underscores that recruitment strategies can create significant compliance risk if not carefully structured.<\/span><\/span><\/p>\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">The Proposed Arrangement.<\/span><\/span><\/h2>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">The opinion evaluates a Medicaid-enrolled home care agency providing in-home support services under a Medicaid program that allows beneficiaries to select their own caregivers, who may include family members or guardians. The agency proposed advertising and offering sign-on bonuses to attract new caregivers, including those who could influence or determine a beneficiary\u2019s choice of home care provider. The requestors specifically represented to OIG that the purpose of the bonuses would be to attract attendants to work for the requestor\u2019s agency over competitors.<\/span><\/span><\/p>\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">OIG\u2019s Analysis and Conclusions.<\/span><\/span><\/h2>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">OIG analyzed the proposed sign-on bonuses under the Employment Safe Harbor,<\/span><\/span><a href=\"#_ftn2\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"><sup>2<\/sup><\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> which shields payments paid by an employer to a \u201cbona fide\u201d employee. OIG acknowledged that sign-on bonuses are \u201cordinary offerings in the course of employment contracting\u201d and are \u201coften low risk\u201d under the AKS. In this case, however, OIG concluded that the sign-on bonuses would not fall within the Employment Safe Harbor because of an \u201cinextricable link\u201d between hiring a family caregiver and the referral of a particular client. According to OIG, each sign-on bonus results in an \u201call but guaranteed referral.\u201d<\/span><\/span><\/p>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">OIG appeared to focus on the <\/span><\/span><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:italic\">form<\/span><\/span><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> and <\/span><\/span><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:italic\">timing<\/span><\/span><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> of the bonus offer. The opinion notes that prospective family caregivers \u201cmay readily interpret the advertisement of the Sign-On Bonus as an upfront payment that they would receive upon signing an employment contract and prior to the performance of any work under their employment contract.\u201d Thus, the sign-in bonus would not be in exchange for provision of covered items or services under an employment relationship\u2014which would be protected by the Employment Safe Harbor\u2014but would instead be paid solely to reward referrals. The opinion also notes that the bonus would be advertised \u201conly as to the amount of the bonus,\u201d i.e., the recruitment and marketing materials would attach no particular conditions to the bonus, further suggesting, in OIG\u2019s view, that the bonus would reward referrals rather than function as employment compensation.<\/span><\/span><\/p>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">After concluding that the safe harbor was not met, OIG analyzed the potential fraud and abuse risk presented by sign-on bonuses, noting concerns about patient steering, unfair competition and quality of care. OIG appears concerned that an ever-escalating war over sign-on bonus amounts could distort competition in the home care marketplace and cause agencies to overspend on signing bonuses at the expense of ensuring high quality care. Interestingly, OIG also concluded that, in this circumstance, the sign-on bonus paid to family caregivers implicated the Beneficiary Inducements CMP. Although typically only applicable to payments made directly to beneficiaries, OIG reasoned that family caregivers are \u201cin a position to select\u201d the home care agency for the beneficiary, and the sign-on bonus could influence that selection.<\/span><\/span><\/p>\n<h2 style=\"margin-top:24px; margin-bottom:5px\"><span style=\"font-weight:700; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Takeaways for Home Care Agencies.<\/span><\/span><\/h2>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">While the advisory opinion only applies to the specific facts presented and the requesting party, it signals a potential narrowing of OIG\u2019s view of the otherwise expansive Employment Safe Harbor. In light of this opinion, Medicaid-participating home care agencies should carefully evaluate their sign-on bonus programs to determine whether updates are necessary to maintain compliance with current OIG perspectives. Providers should evaluate factors such as:<\/span><\/span><\/p>\n<ul>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">The relationship between the recipient of the sign-on bonus and potential client referrals;<\/span><\/span><\/li>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">The timing of the advertisement, offer and payment of a sign-on bonus;<\/span><\/span><\/li>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">The intent and purpose of the bonus program; and<\/span><\/span><\/li>\n<li aria-level=\"1\" style=\"list-style-type:disc\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">Other (non-referral related) factors relevant to the provider\u2019s decision to offer a bonus.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"margin-bottom:28px\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">The opinion does not address many variations on compensation and bonus arrangements that could dramatically alter the risk profile under different circumstances, leaving an opportunity for home care providers to innovate and develop compensation models that achieve their commercial goals while reducing risk of enforcement.<\/span><\/span><\/p>\n<hr\/>\n<p style=\"margin-bottom:28px\"><a href=\"#_ftnref1\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">[1]<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> 42 U.S.C. \u00a7 1320a-7a(a)(5).<\/span><\/span><\/p>\n<p><a href=\"#_ftnref2\"><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\">[2]<\/span><\/span><\/a><span style=\"font-weight:400; font-variant:normal; white-space:pre-wrap\"><span style=\"font-style:normal\"> 42 U.S.C. \u00a7 1320a-7b(b)(3)(B); 42 C.F.R. \u00a7 1001.952(i).<\/span><\/span><\/p>\n<p>[<a href=\"https:\/\/www.polsinelli.com\/publications\/advisory-opinion-signals-risks-sign-on-bonuses-home-care\" target=\"_blank\" rel=\"nofollow noopener\">View source<\/a>.]<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Key Takeaways: In a rare unfavorable advisory opinion, OIG concluded that certain sign-on bonuses for home care workers are a risk under the federal Anti-Kickback Statute, despite historical [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":9736,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[3791,4611,4433,451,2007,1283,7391,5612,2672,7392,2740,3074,5274,7393],"class_list":["post-9735","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lawyers","tag-advisory","tag-bonuses","tag-care","tag-employment","tag-harbor","tag-home","tag-oig","tag-opinion","tag-polsinelli","tag-reels","tag-risks","tag-safe","tag-signals","tag-signon"],"_links":{"self":[{"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/posts\/9735","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/comments?post=9735"}],"version-history":[{"count":0,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/posts\/9735\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/media\/9736"}],"wp:attachment":[{"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/media?parent=9735"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/categories?post=9735"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/usatrustedlawyers.com\/blog\/wp-json\/wp\/v2\/tags?post=9735"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}