PWW is a full-service EMS law firm. We represent clients in matters including Medicare and Medicaid billing, private payor reimbursement, health care compliance, labor and employment law, nonprofit corporate and tax exempt law, response area and competition issues, litigation and a wide range of other EMS law issues.

Our clients include ambulance services, EMS organizations, medical transportation companies, air medical providers, fire departments, municipalities, billing companies, software developers, trade associations, dispatch agencies and other organizations involved in EMS and public safety throughout the United States.

Contact us to learn how we can assist your EMS organization in protecting your interests, improving your bottom line with integrity or in assessing and improving your compliance with applicable laws.

Legal Practice Areas

Ambulance Billing & Reimbursement Law

Page, Wolfberg & Wirth provides legal counsel and advocacy services to EMS organizations, medical transportation providers, ambulance trade and industry associations, billing agencies and others regarding proper billing and reimbursement practices and policies for their services.

Medicare Advice.  PWW has wide-ranging expertise in Medicare reimbursement for ambulance services.  We are nationally recognized as leading advocates for the ambulance industry and represent providers in Medicare audits, appeals, and other payment issues. We also perform claim reviews and internal billing assessments to help ambulance services measure and improve their compliance with applicable payment rules.

Appeals.  We represent EMS organizations throughout the United States in navigating the complex appeals processes of Medicare and other payors. We represent clients at all levels of appeal, including redeterminations, Qualified Independent Contractor (QIC) appeals, Administrative Law Judge (ALJ) hearings, and court challenges when appropriate. The professionals at PWW are familiar with the issues most often raised in these cases, such as medical necessity determinations, ambulance supplier eligibility and certification requirements, origin and destination requirements, and a host of other ambulance-specific issues.

Managed Care.  We understand the managed care industry as it affects EMS and medical transportation providers. We assist ambulance providers in obtaining timely and proper reimbursement from HMOs and other managed care organizations under the specific provisions of the various plans and policies at issue. We are familiar with a host of federal and state laws that affect payment of ambulance services by managed care organizations.  We also draft and negotiate "participating provider" agreements between providers and managed care networks.

Medicaid.  We have represented ambulance services across the country in pursuing Medicaid rate increases and in audits, appeals and investigations with regard to their Medicaid billing.  We have successfully represented state ambulance associations in obtaining statewide rate increases for ambulance services through legislative advocacy and litigation.

Commercial Reimbursement.  PWW works with ambulance services and EMS organizations throughout the United States in ensuring that they are paid promptly, completely and fairly by commercial insurers and other third-party payors.  We pursue appeals and grievance processes regarding commercial reimbursement and have pursued litigation when necessary on behalf of our clients.

Reimbursement Audits and Investigations.  PWW represents ambulance providers involved in audits and investigations brought by government agencies, Medicare carriers and others. We help our clients ensure that their rights are protected in these matters and that any interruptions to cash flow from prepayment review, suspensions or other sanctions are minimized. 

Provider Enrollment Issues.  PWW professionals work with clients in obtaining Medicare provider numbers and National Provider Identifier numbers, and In maintaining billing privileges and updating their provider enrollment status as necessary. We can assist ambulance services in navigating the complicated CMS 855 form and provider enrollment process. 

Pricing.  We counsel our clients in accurately assessing their costs for purposes of establishing their fees and charges for their services. We also provide clients with advice regarding discounting their services and ensuring compliance with the federal anti-kickback statute and other applicable laws.

Billing Implementation.  We have represented some of the largest municipalities in the United States in the implementation of ambulance billng programs, including the drafting and development of Requests for Proposal (RFPs) and similar documents for the procurement of billing services, data collection hardware and software and other vital components to the implementation of a successful ambulance billing program. 

EMS and Medical Transportation Contracting 

Page, Wolfberg & Wirth drafts and negotiates contracts on behalf of EMS and medical transportation providers in all facets of their business and operations. One of our paramount considerations in this area is ensuring that our clients’ contractual arrangements comply with the complex federal fraud and abuse laws, such as the anti-kickback statute. We also counsel our clients on the legality of discounting, “first call” provisions, referrals and other such arrangements. Our services permit our clients to negotiate their arrangements armed with EMS-specific contracts and not the “boilerplate” contracts often provided by facilities and others who may not be knowledgeable about ambulance service. Specific areas include:

Facility Contracts.  We draft contracts for ambulance and medical transprortation providers with skilled nursing facilities, hospitals, multi-institution health care systems, rehabilitation centers, psychiatric hospitals, and other facilities and entities. We put our experience to work to give our clients every advantage in their contractual arrangements, and to make sure their contracts are compliant with regard to pricing, inducements and other potential compliance pitfalls.

Managed Care Organizations.  We have experience specific to the ambulance industry in drafting and negotiating contracts with HMOs and other managed care organizations without bargaining away important rights given to EMS providers that may exist under applicable laws.

Joint Billing Arrangements.  We work with clients who provide Ambulance/Paramedic service in a tiered response system to ensure that lawful service and billing arrangements are in place between the transporting and non-transporting service. We draft agreements that help ensure your legal rights when it comes to receiving payment for the services you provide in cooperation with other EMS/ambulance organizations.

Other Contracts. PWW drafts and counsels clients on contractual arrangements in areas including:

• Ambulance service medical director agreements
• Third party billing agency agreements (for both billing agencies and providers)
• Formation of EMS alliances and cooperatives
• Consulting and personal service agreements
• Space, equipment and vehicle leases

Compliance

Page, Wolfberg & Wirth assists EMS organizations along the entire spectrum of compliance planning and program implementation. We help EMS organizations identify problem areas, draft policies and procedures, develop formal compliance programs, train their staff, monitor their programs and help then detect and resolve problems when they arise.

Billing and Compliance Assessments.  We offer both on-site and off-site reviews of our clients' ambulance billing and compliance programs. Conducting periodic billing assessments and internal audits are critical components of any functional compliance program, and can help your ambulance service identify both underpayments and overpayments before they end up posing large headaches or cash flow problems down the road.

Policy Development.  We assist EMS organizations in drafting and implementing appropriate board resolutions, by-laws and policies necessary to implement effective formal compliance program.

Formal Compliance Programs.  We prepare formal compliance programs which help our clients maximize their compliance in areas including reimbursement, fraud and abuse, employment and other areas. These programs are important legal tools both to prevent waste, fraud and abuse, and to offer maximum protection to individuals and organizations.

Implementation and Training.  We offer on-site visits to our clients to participate in one of the most important aspects of the formal compliance program: front-line training and implementation with our clients’ staff members, field personnel and other key employees.

Audits, Investigations and Enforcement Actions.  We have represented the interests of many clients with regard to Medicare audits, OIG investigations, prosecutions and other compliance-related enforcement activities.  We have represented numerous clients in the negotiation and execution of Corporate Integrity Agreements (CIAs) with the Office of Inspector General, and can serve as an Independent Review Organizaton (IRO) for organizations under active CIAs.

Workplace Practices - Labor/Employment Law

Employment Counseling.  Our lawyers counsel managers on recruitment and hiring, employee conduct, discipline and termination issues and, where appropriate the use of alternative dispute resolution procedures. We also provide advice in connection with the sale, merger or acquisition of organizations. We also advise clients on how to manage leave-of-absence issues, including medical and other leaves under the Family and Medical Leave Act. Our philosophy is to practice preventive employment law, and thus we believe that we best serve you by increasing your awareness about potential problems in the workplace through on-site and regional seminars on these and other issues.

Workplace Compliance Programs.  We counsel employers on compliance issues related to employment discrimination, wage and hour, family and medical leave, employee benefits, workplace safety, and "whistleblower" protection. We conduct onsite reviews of all facets of the workplace and review and advise employers on policies and procedures that are necessary. We assist the employer in integrating corporate compliance programs into the human resource function, to ensure compliance with federal and state reimbursement policy and the policies established by the Office of Inspector General.

Employment Discrimination.  We defend employers before administrative agencies and the courts when charges of unlawful discrimination based on age, disability, sex, race, national origin, religion are raised. We assist employers in conducting workplace investigations when there are accusations of sexual harassment and other wrongdoing, consistent with recent legal developments in this ever-changing area of the law. Our focus is on preventing legal problems in the first place, and to that end, our attorneys conduct on-site workplace training for executives, managers and employees, and we assist in implementing policies and procedures that aid in developing a positive employee relations program for your organization.

Pay Practices.  We advise employers on lawful practices under the Fair Labor Standards Act (FLSA) and other laws which mandate how and when employees are paid for their services. We conduct on-site pay practice audits and defend employers in wage and hour claims brought before administrative agencies, such as the U.S. Department of Labor, and the courts. We assist volunteer and partial-paid services in developing lawful incentive programs and in the transition to full or part-time paid staff.

Labor Law.  We advise employers and managers on lawful practices under the National Labor Relation Act, which regulates the relationshiip between employees and labor unions. We assist EMS employers in dealing with union petitions, and in their relationships with the collective bargaining agent. We assist in union avoidance strategies, negotiate collective bargaining agreements, and defending employers in cases of alleged unfair labor practices.  

Air Medical Services

PWW provides a full range of services to air medical organizations.  In addition to all of the services provided on this page, PWW provides focused advice and expertise in the unique challenges facing medical aviation providers.  We have experience in assisting air medical organizations in the negotiation and drafting of aircraft leases, operating agreements, charter services agreements and related contracts and documents.  We have also counseled clients with regard to the EMS law aspects of FAA investigations and the unique regulatory challenges faced by many so-called "piggyback" arrangements between air ambulance services and aircraft operators certificated under Part 135 of the Federal Aviation Regulations.  This includes specific experience with cases involving FAA allegations of the improper franchising of "operational control" by the air operators to the air medical organizations.

Nonprofit and Tax-Exempt Organization Issues

IRS Exempt Organization Law.  We have specific experience counseling EMS organizations in obtaining tax-exempt status under Section 501(c)(3) and other sections of the Internal Revenue Code. We work closely with an organization's officers and accountants to compile the necessary information to make the determination process as efficient as possible.

We have also worked with many nonprofit EMS organizations that cannot locate any records of their tax-exempt status, and work closely with the organization and the IRS in "getting the house in order." We find that many nonprofit organizations, particularly ambulance services that have been in existence for decades, have paid scant attention to their IRS obligations, including obtaining an IRS determination of exempt status, and filing the annual informational returns (Form 990) required of exempt organizations. We help the organization bring itself into compliance with all of its IRS obligations.

We also counsel tax-exempt organizations in understanding their obligations to make certain documents publicly available under IRS regulations.

Page, Wolfberg & Wirth also works closely with its tax-exempt clients and their accountants to understand their obligations to file tax returns when they earn "unrelated business income," which must be reported on a Form 990-T, and whether earning a certain amount of unrelated business income or engaging in certain activities can jeopardize an organization's tax-exempt status.

State Nonprofit Corporation Laws.  We work closely with nonprofit organizations and provide counsel regarding their obligations and options under state nonprofit corporation laws. We have formed subsidiaries of nonprofit organizations and can draft or re-draft a nonprofit organization's by laws to protect the organization and its officers and directors. We prepare and file Articles of Incorporation, Articles of Amendment, Articles of Merger and related documents to effect incorporation and fundamental change transactions when necessary, and can counsel clients on the legal aspects surrounding the disposition of charitable assets. We represent nonprofit clients in navigating the attorney general's approval requirements for fundamental change transactions involving health care entities, and in obtaining court approvals where necessary.

We can also assist nonprofit organizations in obtaining fictitious name registrations, in name changes and in a variety of related matters.  

Response Areas and Competition Issues

We represent ambulance companies, municipalities and other agencies involved in territory disputes regarding primary response areas. We assist our clients in understanding the legal rights and remedies of each party in the process and challenge primary response area decisions before local government agencies or the courts when necessary.  We have litigated cases in many states to help protect or defend companies and governmental agencies in this complex and ever-changing area of the law, and some of our cases have led to important and groundbreaking court decisions in this area.

Some of the other services we provide in this area of our practice include:

Municipal Contracting.  We counsel both providers and municipalities in issues surrounding the public contracting process for the provision of ambulance or other public safety services. We can help ensure that the recruitment and selection process conforms with applicable laws and that the provisions of any such contract fully comply with the obligation of both the provider and municipality under applicable federal laws, including the False Claims Act and the Anti-Kickback Statute.

Primary Response Designations.  We counsel clients on the legal issues surrounding the “designation” of ambulance providers as primary responders by municipal agencies. We can help determine whether any such municipal ordinances or resolutions conform to applicable law.

Exclusive Operating Area (EOA) Designations.  We have worked with private and public clients in the design and management of Exclusive Operating Areas - including the planning and implementation of competitive procurement processes for the selection of exclusive providers in many jurisdictions.

Municipal Relations.  We assist ambulance and other public safety organizations in dealing with their local elected officials. These relationships sometimes turn contentious and various legal issues can arise when municipalities attempt to unduly regulate their public safety agencies. We advocate on behalf of our clients to ensure that their legal rights are preserved in any such matters.

Antitrust Law.  We work with private and public clients in helping them to understand, clarify, and, when necessary, litigate their rights and obligations with respect to antitrust laws and their impact on the ambulance marketplace in their service areas.

Litigation

PWW attorneys are experienced litigators and are prepared to aggressively pursue or defend our clients' rights - as plaintiffs or defendants - in a wide range of court cases whenever necessary.  We have litigated key cases on behalf of ambulance services, public agencies and other clients against managed care organizations, regulatory agencies, other municipalities, debtors, and others.  Through our litigation services, we have assisted state associations in obtaining statewide Medicaid rate increases for ambulance services, and fought for the rights of ambulance services against some of the largest HMOs in the United States.  We have also instituted or defended breach of contract cases, collection actions, reimbursement appeals and disputes, antitrust cases, bidding and procurement challenges, and a wide range of other court cases - both at the trial and appellate levels.

Training and Education

The attorneys and consulting professionals of PWW spend a great deal of time providing education and training to the ambulance industry and EMS profession on a wide range of topics.  We are available to speak at local, regional, statewide or national conferences, seminars, courses or other events, and our presenters are consistently rated among the best speakers in the industry. Our presentations blend humor with a serious message - all while relating our decades of hands-on experience both in the delivery of EMS and in the law.  For more detailed information on our presentation topics and fees, see our online presentation catalog.

Other Practice Areas

Fire Service Issues.  Our late founding partner, James O. Page, was a Los Angeles Fire Department battalion chief and was named as one of the 20 most influential fire chiefs of the 20th Century by Fire Chief magazine. In addition, Steve Wirth and Doug Wolfberg have both had experience in volunteer fire departments as line officers and members. We understand the challenges that face the fire service in areas of funding, municipal government relationships and cutting-edge issues like third party billing for fire suppression, rescue and extrication services.

Dispatch Law.  The attorneys of Page, Wolfberg & Wirth, LLC have been at the forefront of dispatch liability issues in the United States. We have presented at some of the dispatch industry's leading seminars and events, written articles in dispatch publications, and represented dispatch agencies in all manner of legal issues.  We also work with ambulance services to improve their internal call intake practices to maximize efficiency, compliance and reimbursement in this critical, but often overlooked, area of their organizations.

Hospital Law.  Our detailed knowledge of emergency medical services law has made Page, Wolfberg & Wirth a natural choice to serve as special counsel to hospitals regarding emergency services issues that confront them on a daily basis. For instance, we counsel hospitals on their obligations under the Emergency Medical Treatment and Active Labor Act and follow the latest court decisions and agency rulings that affect this every-changing area of the law. We are also experienced in counseling hospitals on their operation of hospital-based EMS units. In addition, we represent health care facilities in their labor and employment matters.