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
Clay Countryman_cropped

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