OIG Compliance Program Guidance for Ambulance Suppliers

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Inspector General

OIG Compliance Program Guidance for Ambulance Suppliers

AGENCY: Office of Inspector General (OIG), HHS.

ACTION: Notice.

SUMMARY: This Federal Register notice sets forth the recently issued Compliance Program Guidance for Ambulance Suppliers developed by the Office of Inspector General (OIG). The OIG has previously developed and published voluntary compliance program guidance focused on several different areas of the health care industry. This voluntary compliance program guidance should assist ambulance suppliers and other health care providers in developing their own strategies for complying with federal health care program requirements.

FOR FURTHER INFORMATION CONTACT: Sonya Castro, (202) 619–2078, or Joel Schaer, (202) 619–1306, Office of Counsel to the Inspector General.

SUPPLEMENTARY INFORMATION:

Background

The creation of compliance program guidances (CPGs) is a major initiative of the OIG in its effort to engage the private health care community in preventing the submission of erroneous claims and in combating fraudulent and abusive conduct. In the past several years, the OIG has developed and issued CPGs directed at a variety of segments in the health care industry. The development of these CPGs is based on our belief that a health care provider can use internal controls to more efficiently monitor adherence to applicable statutes, regulations, and program requirements. Copies of these CPGs can be found on the OIG Web site at http://oig.hhs.gov.

Developing Compliance Program Guidance for Ambulance Suppliers

Having experienced a number of instances of ambulance provider and supplier fraud and abuse, the ambulance industry has expressed interest in protecting against such conduct through increased guidance to the industry. To date, the OIG has issued several advisory opinions on a variety of ambulance-related issues (see endnote 13 in this compliance program guidance) and has published final rulemaking concerning a safe harbor for ambulance restocking arrangements (66 FR 62979; December 4, 2001).

To provide further guidance, the OIG published a Federal Register notice (65 FR 50204; August 17, 2000) that solicited general comments, recommendations, and other suggestions from concerned parties and organizations on how best to develop compliance guidance for ambulance suppliers to reduce the potential for fraud and abuse. On June 6, 2002, the OIG published a Draft Compliance Program Guidance to afford all interested parties a further opportunity to provide specific comments in the development of this final CPG (67 FR 39015; June 6, 2002). In response to that notice, the OIG received three public comments, collectively representing a variety of outside sources. We have carefully considered those comments, as well as previous OIG publications, and have consulted with the Centers for Medicare and Medicaid Services (CMS) and the Department of Justice in developing final guidance for ambulance suppliers. This final guidance outlines some of the most common and prevalent fraud and abuse risk areas for the ambulance industry and provides direction on how to: (1) Address various risk areas; (2) prevent the occurrence of instances of fraud and abuse; and (3) develop corrective actions when those risks or instances of fraud and abuse are identified.

This CPG is divided into the following five separate sections, with an appendix:

  • Section I is a brief introduction.
  • Section II provides information about the basic elements of a compliance program for ambulance suppliers.
  • Section III discusses various fraud and abuse and compliance risks associated with ambulance services covered under the Medicare program.
  • Section IV briefly summarizes compliance risks related to Medicaid coverage for transportation services.
  • Section V discusses various risks under the anti-kickback statute.
  • Section VI – Conclusion
  • The Appendix provides relevant statutory and regulatory citations, as well as brief discussions of additional potential risk areas to consider when developing a compliance program.

Under the Social Security Act (the Act), ambulance ‘‘providers’’ are Medicare participating institutional providers that submit claims for Medicare ambulance services (e.g., hospitals, including critical access hospitals (CAHs) and skilled nursing facilities (SNFs); the term ‘‘supplier’’ means an entity that is other than a provider. For purposes of this document, we will refer to both ambulance suppliers and providers as ambulance ‘‘suppliers.’’