Oct 31, 2017 the antikickback statute aks makes it illegal to give or receive anything of value, which of course would include receiving discounted ambulance services. Department of health and human services the oig published in the federal register a final rule final rule that, among other things, adds three new safe harbors to the anti kickback statute, and expands the exceptions to the definition of remuneration that is prohibited under the civil monetary penalties cmp statutes and regulations. New antikickback safe harbors and exceptions to cmp law. Core of the anti kickback statute prohibits anyone from purposefully offering, soliciting or receiving anything of value to generate referrals for items or services payable by any federal healthcare program. Oig announces new ambulance aks safe harbor quick med. It is worth noting that under the anti kickback statute, meeting a safe harbor is not mandatory. A violation of the anti kickback statute is also a violation of the false claims act as compliance with the law is a condition of payment under medicare and medicaid. The first thing that comes to mind when someone hears the word kickback is a cash bribe. The antikickback statute for whistleblowers the antikickback statute is a federal law that prohibits payments to induce referrals for items or services that are covered by a federal healthcare program, such as medicare and medicaid. New safe harbors to the federal antikickback law, including allowing hospitals and other eligible entities to provide local transportation for medicare patients, became effective january 6, 2017. The office of the inspector general oig issued a new rule pertaining to governmentowned and operated ambulance providers and suppliers this week regarding the waiving of medicare copayments and deductibles for emergency ambulance services under the federal anti kickback statute aks. A key government weapon in the antifraud campaign is the federal antikickback statute aks, 42 u. We are currently investigating whether any of the air ambulance companies or hospitals that operate a helicopter ems service are paying illegal kickbacks. Congress passed the anti kickback statute, a law that makes it illegal to pay or give anything of value in an attempt to influence a healthcare decision.
Not only are kickbacks illegal under the antikickback statute, they also. To better understand this post, some brief history is useful. Ambulance restocking arrangements technically implicate the anti kickback statute because the receiving hospital gives something of value e. Rin 0991ab05 medicare and state health care programs. Jul 24, 2014 the antikickback statute allows discounts under one of the laws safe harbors, which denotes that exemptions exist for healthcare providers who submit claims to medicare and medicaid if those providers properly disclose and accurately report the discounts, and those discounts represent reductions in the prices of goods and services based on. Federal restrictions on pricing ambulance services march 10, 2009 this document is designed to provide an overview of what is required under the federal anti kickback statute and the substantiallyinexcess rule. Rather, arrangements that do not fit in a safe harbor must be analyzed under the anti kickback statute on a casebycase basis to determine if there is a violation. Oig adds new antikickback safe harbors, expands cmp exceptions. Ambulance replenishing under the stark and antikickback laws. Revisions to safe harbors under the antikickback statute, and civil monetary penalties regarding beneficiary inducements. To minimize the risk under the antikickback statute, ambulance suppliers should structure arrangements to take advantage of the protection offered by the safe. If a health care provider violates the kickback law, they are subject to monetary penalties and treble damages under the false claims act. Safe harbor archives american ambulance association.
Air ambulance kickback investigation whistleblower reward. An important area of potential violation under the aks involves discounts that are granted by a supplier of medicare service to other suppliers and providers in order to obtain additional federal health care business. More and more hospitals have been shutting down their ambulance medication and supplies restocking programs lately over concern that they may violate the anti kickback statute, the premise being. The department of health and human services office of inspector general oig recently implemented a new safe harbor to the federal anti kickback statute and beneficiary inducement statute, which went into effect on january 6, 2017. Jan 27, 2016 houston the former owner and operator of houstonarea ambulance company national care ems has agreed to settle allegations that he and the company provided kickbacks to various nursing facilities and hospitals in exchange for rights to the institutions more lucrative medicare and medicaid transport referrals, announced u. Jan 26, 2017 the united states filed a complaint on january 23, 2017, officially intervening in an alleged kickback scheme against east texas medical center regional healthcare system, inc. On thursday, october 17, 2019, the hhs office of the inspector general oig issued a proposed rule titled medicare and state health care programs. The centers for medicare and medicaid services cms and office of inspector general oig issued the final rule regarding waivers of the application of the physician selfreferral law, the federal anti kickback statute, and the civil monetary penalties cmp law provision relating to beneficiary inducements to specified arrangements involving accountable care organizations acos under. Since ambulance companies receive referrals from nursing homes and hospitals, the kickback law could potentially be violated if an ambulance company. Reimbursement provision accrue only when use of a firefighter driver actually results in the. Law the anti kickback statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program. New oig antikickback safe harbors allowing patient transportation and certain copay waivers. On december 7, 2016, the department of health and human services hhs, office of inspector general oig, issued a final rule creating additional safe harbors for the federal antikickback statute 42 usc 20a7bb et seq. A violation of the anti kickback statute would occur if a health care provider was to give or receive any remuneration, directly or indirectly, in return for medicare or medicare referrals.
Jan 12, 2017 on december 7, 2016, the department of health and human services office of inspector general oig issued a longawaited final rule establishing new anti kickback statute aks safe harbor protections and codifying regulatory exceptions to the civil monetary penalties law cmp. Oig ambulance restocking safe harbor regulation page. Antikickback statute definition of antikickback statute. Four houstonarea hospitals affiliated with hca holdings inc. Free transportation services do not violate cmp, anti. Antikickback statute implications of care coordination and the valuebased framework better care coordinationincluding more effective transitions for patients across the care continuum, less duplication of items and services, and open sharing of health data consistent with privacy and security rulesis integrally connected to advancing. The safe harbor regulations, in their entirety, can be found here. Intervenes in east texas false claims act lawsuit alleging kickbacks for ambulance services sherman, texas the united states has filed a complaint intervening in an alleged kickback scheme in the eastern district of texas, announced acting u. Oig finalizes new and amended antikickback and cmp safe.
For purposes of the antikickback statute, remuneration includes the. The transportation is not provided via air, luxury, or ambulancelevel. The anti kickback statute restricts a pharmaceutical firm from offering or paying, directly or indirectly, any remuneration in the form of money or any other thing of value to motivate medicare or champva patients to purchase the companys drugs. Kickbacks and inducements whistleblower healthcare fraud.
Antikickback statute and the false claims act mceldrew. Earlier this month, the department of health and human services office of inspector general oig issued a final rule adding five new safe harbors to the federal anti kickback statute and making a few revisions to existing safe harbors. On december 7, 2016, the office of the inspector general oig published a new safe harbor regulation under the antikickback statute aks. Federal register medicare and state healthcare programs. To minimize the risk under the anti kickback statute, ambulance suppliers should structure arrangements to take advantage of the protection offered by the safe harbors whenever. We redact certain identifying information and certain. Federal register medicare and state health care programs. Attorney kenneth magidson along with gregory demske, chief. Ambulance replenishing safe harbor under the antikickback statute agency. Oig issues safeharbor for government ambulance agencies. First whistleblower was competitor of ambulance companies.
Whistleblowers play an instrumental role in enforcing the antikickback statute. Oig announces new ambulance aks safe harbor breaking news. Jun 12, 2018 the federal anti kickback statute makes it illegal for a healthcare company to give anything of value in exchange for obtaining patients. Safe harbor regulations office of inspector general u. Air ambulance kickback investigation whistleblower reward post. Comparison chart of antikickback safe harbors and stark. New local transportation safe harbor to the antikickback. Jul 06, 2016 congress passed the antikickback statute, a law that makes it illegal to pay or give anything of value in an attempt to influence a healthcare decision.
The federal anti kickback statute makes it illegal for a healthcare company to give anything of value in exchange for obtaining patients. Recent federal advisory opinion favors community paramedic. This means, if an arrangement implicates the anti kickback statute and remuneration is exchanged, then it may not violate the anti kickback statute because it lacks the intent or knowledge element. The safe harbor regulations describe various payment and business practices that, although they potentially implicate the federal anti kickback statute, are not treated as offenses under the statute. A first responder includes, but is not limited to, a fire department, paramedic service or. New safe harbors to the federal anti kickback law, including allowing hospitals and other eligible entities to provide local transportation for medicare patients, became effective january 6, 2017. The antikickback statute 42 usc 20a7bb the stark law 42 usc 95nn prohibition prohibits offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate financial relationship, unless an exception appliesfederal health care. The antikickback statute stipulates that offering, paying, soliciting or receiving remuneration in order to cause referrals of items or services. The secretary of health and human services in this subsection referred to as the secretary shall establish, on an expedited basis and using a negotiated rulemaking process under subchapter 3 iii of chapter 5 of title 5, united states code, standards relating to the exception for risksharing arrangements to the antikickback penalties. Those discounts violated the antikickback statute, according to the doj, which said that the proceeds from part b trips in essence subsidized the discounted trips under part a.
The federal antikickback statute is a healthcare fraud and abuse statute that prohibits the exchange of remunerationwhich the statute defines broadly as anything of valuefor referrals for services that are payable by a federal program, which, in the context of healthcare. Introduction one of the questions that is often raised by ambulance service providers involves legal restrictions on discounting. Generally, the aks prohibits the giving or receiving of remuneration in exchange for or to induce referrals. New oig anti kickback safe harbors allowing patient transportation and certain copay waivers. The oig notes, however, that if a state or municipality uses its residents tax dollars to pay a private ambulance company an amount that is actuarially equivalent to the residents copayment amounts, the antikickback statute would not be implicated since the residents would ultimately be paying for the services. The anti kickback statute and ems ambulance billing. Kickbacks and inducements whistleblower healthcare. On december 7, 2016, the office of inspector general u. Federal pricing restrictions american ambulance association. The government fights back against ambulance fraud.
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