Legal implications of home health care by nonprofit hospitals.

Antitrust considerations and other legal implications of home health-care (HHC) services provided by nonprofit hospitals are discussed, and pertinent legal cases are reviewed. Of the various antitrust laws, the act that is probably most relevant to hospital-based HHC is the Section 13C exemption to the Robinson-Patman Anti-discrimination Act, which allows a nonprofit hospital to purchase drugs for its own use at special discounted prices that would otherwise be illegal. For HHC provided by nonprofit hospitals, a major legal question is the extent to which the Section 13C exemption applies to drugs purchased by a hospital at preferential prices and used to treat the hospital's HHC patients; decisions in the cases of Abbott Laboratories et al. v. Portland Retail Druggists Association and De Modena v. Kaiser Foundation Health Plan have helped to clarify the answer to that question. To avoid allegations of illegal tying arrangements, hospitals should take care that users of their HHC services are not being compelled to purchase or use other hospital services unless they would otherwise do so. Also, hospitals providing HHC services should ensure that the professionals providing those services are aware of and meet the appropriate standards of care for the services rendered to avoid liability for negligence. To be successful in the delivery of HHC services, providers will have to be prepared to address the various legal issues that might arise. Hospital administrators, HHC professionals, and legal counsel should work together as HHC programs develop and evolve.