New OIG Advisory Opinion Regarding Ambulance Services – No. 12-07

I will start out by making the following statements:

  1. This one is pretty obvious.  While you might be able to make a case under a really strict reading of the rules, this doesn’t come close in terms of creating an issue of a kickback, in my opinion; and
  2. I like Greg Demske’s style  of writing these Advisory Opinions.  He is also a really nice guy, personally.

Essentially, this arrangement consisted of a County contracting with a non-profit corporation for all ambulance services in a County. The company billed as usual, but also received payments, collected by the County, as sort of a “subscription fee.” The Company would waive collection efforts if insurance/Medicare/Medicaid didn’t pay, but they billed those who didn’t pay the fee and those visitors who didn’t live in the County.  Apparently the County is rural and has a high percentage of indigent persons.

There are a few other facts that are laid out in the opinion. The concern is that this is a routine waiver of the Part B coinsurance, which CMS frowns upon. But the conclusion is that since the County is paying the Company for those residents that pay the fee, they essentially are acting like a part B coinsurance carrier that pays the out-of-pocket coinsurance for the residents that pay the fee.  Therefore, the waiver of the coinsurance for those residents doesn’t raise any anti-kickback implication, especially since this fee historically exceeded the residents Medicare out-of-pocket coinsurance obligation.

Nice to see a positive Advisory Opinion regarding an Ambulance Service arrangement, again.


Link to the Opinion.

Link to the Opinion on the HHS OIG website.

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