OIG Issues Advisory Opinion on Proposed Billing Arrangements for EMS Services

The Office of Inspector General issued a favorable advisory opinion on August 21, 2013 (Advisory Opinion No. 13-11) regarding two proposed arrangements involving the provision of emergency medical services for a township. In the first proposed arrangement, a basic life support ambulance supplier would not bill bona fide township residents for applicable emergency ambulance cost-sharing amounts, and would instead accept payment from the township for any cost-sharing amounts. Under second proposed arrangement, the basic life support supplier would waive otherwise applicable cost-sharing amounts when providing backup emergency ambulance services to certain patients pursuant to mutual aid partnerships with towns in the surrounding area.

The OIG concluded that the proposed arrangements would not constitute grounds for the imposition of civil monetary penalties under section 1128A(a)(5) of the Act, and although they could potentially generate prohibited remuneration under the Federal Anti-kickback statute, the OIG would not impose administrative sanctions under sections 1128(b)(7) or 1128A(a)(7) of the Act.

A copy of this advisory opinion is available on the OIG’s web site at: http://oig.hhs.gov/fraud/docs/advisoryopinions/2013/AdvOpn13-11.pdf.

Written by: Clay Countryman
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OIG Recommends That CMS Review Critical Access Hospitals For Compliance With Medicare Enrollment Requirements

The Office of Inspector General (OIG) issued a report on August 15, 2013 in which the OIG concluded that two-thirds or 856 of the Medicare enrolled Critical Access Hospitals (CAHs) did not meet the location and distance requirements for a hospital to be enrolled with Medicare as a CAH. Hospitals can be certified as CAHs if they meet various regulatory requirements, including being located at least a certain driving distance from other hospitals and being located in rural areas. Medicare reimburses CAHs at 101 percent of their reasonable cost.

The OIG also commented that if CMS had decertified CAHs that were 15 or fewer miles from their nearest hospitals in 2011, the Medicare program would have saved $449 million. The OIG recommended that CMS take several actions to ensure a hospital’s compliance with the CAH requirements, including that CMS periodically reassess CAHs for compliance with all location-related requirements.

A copy of the OIG this report, “Most Critical Access Hospitals Would Not Meet the Location Requirements if Required to Re-enroll in Medicare” is posted on the OIG website at http://OIG.hhs.gov/ under the “What’s New” tab.

Written by: Clay Countryman
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Failure to Erase PHI from Photocopiers leads to $1.2 million HIPAA Settlement for Affinity Health Plan

New York insurer Affinity Health Plan will pay $1.2 million to resolve allegations it breached HIPAA by returning leased photocopiers without deleting all information from the hard drives of the copiers that contained protected data involving 345,000 patients, federal regulators said on Wednesday, August 14. Affinity reported the breach as required by the breach notification rules in the HITECH Act of 2009 and Omnibus Rule released this year.

Affinity learned of the breach from reporters at CBS Evening news, who purchased one of the copiers and discovered ePHI on the hard drives. This is another harsh reminder that copy machines are a frequent source of unsecured PHI that is not generally scrubbed by the health care provider.

Affinity entered into a Corrective Action Plan that addressed their failure to provide physical safeguards outlined in the Security Rule, lack of a proper risk analysis to determine potential vulnerabilities, as well as insufficient policies and procedures applicable to the issue. “This settlement illustrates an important reminder about equipment designed to retain electronic information: Make sure that all personal information is wiped from hardware before it’s recycled, thrown away or sent back to a leasing agent,” said Leon Rodriguez, director of HHS’s Office for Civil Rights.

Written by: Stephen Angelette

OIG Issues Advisory Opinion 13-09 on Ownership Interests in Group Purchasing Organization By Hospitals and Other Providers

On July 16, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) issued an unfavorable Advisory Opinion concerning an arrangement involving a proposal to offer members of a group purchasing organization (GPO) an equity interest in the GPO’s parent organization in exchange for the member to:

  • Extend its contract with the GPO for 5 to 7 years;
  • Commit not to decrease purchasing volume; and
  • Relinquish its right to a portion of the administrative fees that would otherwise have been passed through to the members.

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