OIG releases draft guidance for ambulance providers

The Health and Human Services Office of Inspector General (OIG) released a draft compliance program guidance for ambulance providers June 6 that offers these companies considerable flexibility. "The OIG recognizes the variation among ambulance suppliers to highlight its view that compliance programs should be tailored to the individual ambulance supplier’s situation and needs," says attorney Howard Young of the law firm Arent Fox in Washington, DC.

In fact, the guidance "goes on at length" to acknowledge that the ambulance industry is an "incredibly diverse" assortment of small and large companies, for-profit and not-for-profits, independent and provider based, municipal and private, says Young, one of the primary authors of the guidance when he was with the OIG.

That said, ambulance providers should study the guidance carefully, Young recommends. In recent years, federal and state fraud and abuse enforcement authorities have hotly pursued ambulance companies for alleged billing fraud on the Medicare and Medicaid programs.

"Kickback arrangements have also been an area of enforcement concern," says Young, noting numerous criminal prosecutions involving ambulance suppliers and the "intense interest" in obtaining OIG advisory opinions on ambulance restocking programs.

According to AAA’s attorney, Darrel Grinstead of Hogan & Hartson in Washington, DC, the new element in the draft guidance is its attempt to identify specific compliance risks associated with services covered under the Medicare program. In particular, the guidance attempts to take into account the new requirements in the Medicare ambulance fee schedule and to provide not only an interpretation of those requirements but also suggestions for ambulance suppliers to operate in compliance with the new requirements.

"While this will be a useful tool when it is complete, this draft needs to be reviewed very carefully to ensure that it is consistent with guidance from the Centers for Medicare and Medicaid Services on the same issues and that the guidance is reasonable from a practical, operational standpoint," he says. The association has identified several points where the draft guidance differs from recent guidance published by CMS, he adds.

According to Grinstead, the draft guidance also briefly discusses Medicaid compliance issues and sets forth a detailed discussion of the applicability of the anti-kickback rules to ambulance services. "The discussion provides no new guidance in this area, but it does provide a useful summary of the OIG’s views on the compliance issues raised by the anti-kickback statute and regulations," he explains.

The draft guidance, which is available at www.hhs.gov, calls for the submission of written comments to the OIG by July 22, 2002.

companies, for-profit and not-for-profits, independent and provider based, municipal and private, says Young, one of the primary authors of the guidance when he was with the OIG.

That said, ambulance providers should study the guidance carefully, Young recommends. In recent years, federal and state fraud and abuse enforcement authorities have hotly pursued ambulance companies for alleged billing fraud on the Medicare and Medicaid programs.

"Kickback arrangements have also been an area of enforcement concern," says Young, noting numerous criminal prosecutions involving ambulance suppliers and the "intense interest" in obtaining OIG advisory opinions on ambulance restocking programs.

According to AAA's attorney, Darrel Grinstead of Hogan & Hartson in Washington, DC, the new element in the draft guidance is its attempt to identify specific compliance risks associated with services covered under the Medicare program. In particular, the guidance attempts to take into account the new requirements in the Medicare ambulance fee schedule and to provide not only an interpretation of those requirements but also suggestions for ambulance suppliers to operate in compliance with the new requirements.

"While this will be a useful tool when it is complete, this draft needs to be reviewed very carefully to ensure that it is consistent with guidance from the Centers for Medicare & Medicaid Services on the same issues and that the guidance is reasonable from a practical, operational standpoint," he says. The association has identified several points where the draft guidance differs from recent guidance published by CMS, he adds.

According to Grinstead, the draft guidance also briefly discusses Medicaid compliance issues and sets forth a detailed discussion of the applicability of the anti-kickback rules to ambulance services. "The discussion provides no new guidance in this area, but it does provide a useful summary of the OIG's views on the compliance issues raised by the anti-kickback statute and regulations," he explains.