Even token giveaways could put you at risk

Giving paramedics meal vouchers and waiving tuition for educational events might seem harmless, but examine these practices carefully to avoid violations of federal anti-kickback laws, advises Michael Williams, president of the Abaris Group, a consulting firm specializing in emergency services based in Walnut Creek, CA.

"Even the potential for inducement to refer could be a violation," Williams adds.

Potential violations include educational activities above and beyond contractual obligations or for programs commonly available elsewhere in the market, he says.

"I don’t think ED managers need to wholesale get rid of practices such as education," he says. "Rather, you should make sure they are grounded in clear legal or contractual obligations, such as a hospital contract with the state EMS agency."

An actual inducement does not have to happen, he notes. "Do not be lulled into the perception that if you are the only hospital in town or the ambulance service does not have a choice, that you could not be guilty of a kickback. If it looks, acts, or smells like an inducement — regardless of intent — this could be a violation."

It is the intent that matters, not the amount of incentive or whether it actually had an effect, Williams emphasizes. "Deep down we really know what is being done here," he says. "Historically, we can honestly say that some EDs do this to encourage ambulances to come to their ED. It is as simple as that."

If there is even an implication of intent, it is a violation of one or more statutes, he says. "It does not matter if it is for one or many ambulances, if there is actual or potential intent to induce."