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8 Big Findings From the OIG’s Utilization Report

September 25, 2013, the Department of Health and Human Services Office of Inspector General (OIG) released a Report, Utilization of Medicare Ambulance Transports, 2002-2011, that takes a critical look at the growth of Part B Medicare ambulance transports since 2002. The Report finds that since...

New OIG Advisory Opinion Allows No Bills for Municipal Residents, But Bills for Non-Residents

On July 9, 2013 the OIG posted Advisory Opinion 13-08, concerning a Fire Protection District ("District") policy of only billing individuals that reside outside the fire protection district for emergency medical services. Here, the District does not bill any residents or their insurers (including federal health care programs) for emergency medical services. But it does bill all...

OIG Issues Updated Special Advisory Bulletin on Excluded Individuals

Background

On May 8, 2013, the Office of the Inspector (OIG) issued an updated “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs.” Ambulance providers enrolled in Federal healthcare programs may not employ or contract with any party who is excluded from...

OIG Report on Claims with G Modifiers

On May 3, 2013 the OIG issued: Medicare Payments for Part B Claims with G Modifiers, assessing how Medicare contractors are processing G modifiers. The OIG analyzed all Part B claims with GA, GZ, GX, or GY modifiers from 2011 and found that there were “vulnerabilities in how Medicare pays for these claims” resulting in improper payments of claims submitted with G...

CMS Publishes New Fraud and Abuse Measures

Significant Impact on Ambulance Services

On February 2, 2011 the Centers for Medicare and Medicaid Services (CMS) published a Final Rule that drastically enhances the government’s ability to crack down on fraud and abuse in federal healthcare programs. For the ambulance industry, this means increased compliance obligations and more scrutiny from federal and state investigators.

Below is an overview of the pertinent provisions of the Final Rule.

The Final Rule establishes new...

Important New OIG Advisory Opinion Issued

OIG Reaffirms Position on Discounting Ambulance Rates to SNFs

On December 28, 2010 the Office of the Inspector General issued a key Advisory Opinion for the ambulance industry, reaffirming its stance that offering discounted rates to skilled nursing facilities (SNFs) could violate the Federal anti-kickback statute (AKS). The OIG held that a prospective arrangement, where an ambulance service provider wanted to offer SNFs “below-cost” rates for Medicaid transport services, could be seen as illegally offering something of...

Court Case Illustrates Importance of Following Patient Refusal Guidelines

A federal appeals court ruled that an EMS agency whose personnel allegedly failed to follow the wishes of a competent patient could be liable under the Americans With Disabilities Act (ADA) as well as under state tort law for transporting the patient against his will.

In Green v. City of New York (read the entire court case by ...

PWW Article - The Discounting Dilemma

How much can you discount your services without getting in trouble with the law? A good question for which at this point, no one has a clear answer. This brief article attempts to put the issue in perspective and remove some of the “cloud of uncertainty” that goes with it.

Overview of the Problem

A key government weapon in the anti-fraud campaign is the federal Anti-Kickback Statute (AKS), 42 U.S.C. § 1320a - 7b(b). An...

OIG Ambulance Restocking Safe Harbor Regulation

Ambulance Restocking - Final Safe Harbor Regulation

[Federal Register: December 4, 2001 (Volume 66, Number 233)]

[Rules and Regulations]

[Page 62979-62991]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr04de01-22]

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PWW Article - OIG Ambulance Restocking Regulations

The final "safe harbor" regulation on ambulance restocking was published by the OIG in the Federal Register on December 4, 2001. The regulations, which become effective on January 3, 2002, establish "safe harbors" under the Federal Anti-Kickback Statute to permit, under certain conditions, the replenishing of drugs, linens and supplies by hospitals to ambulance services. There are some significant changes from the proposed regulations published last year.

In brief, the safe harbor...

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