In a two month time span, December 2021 thru January 2022, three privately owned ambulance services entered into a settlement with the Office of Inspector General (OIG) for allegedly violating the False Claims Act.
On January 5, 2022, a New York based private ambulance company entered into a plea agreement with the OIG to settle allegations that it presented claims to Medicare Part B for ambulance transportation to and from Skilled Nursing Facilities (SNF) where such transportation was already covered by the SNFās consolidated billing payment under Medicare Part A. The ambulance company agreed to pay $430,000 to settle the allegations with the OIG.
On December 7, 2021, a San Diego private ambulance company entered into a plea agreement with the OIG to resolve allegations that it presented claims to Medicare Part B for ambulance transportation to and from SNFs where such transportation was already covered by the SNFās consolidated billing payment under Medicare Part A. The private ambulance company agreed to pay $22,347.89 and be excluded from participation in all Federal healthcare programs for five years.
Also on December 7, 2021, a Massachusetts private ambulance company entered into a plea agreement with the OIG to resolve allegations that it presented claims to Medicare Part B for ambulance transportation to and from SNFs where such transportation was already covered by the SNFās consolidated billing payment under Medicare Part A. The private ambulance company agreed to pay $638,504.62 to settle the allegations with the OIG.
Issue:
It is extremely important that all members of the healthcare team are aware of what may be considered a false claim. Ensure that all staff are aware that these violations can occur whether they are intentional or not intentional. Failure to promptly report a false claim can result in lawsuits, fines, and other sanctions. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1 Compliance and Ethics Program, CP 2.3 General Legal Duties and Antitrust Laws.
Discussion Points:
- Review policies and procedures for preventing and reporting false claim violations. Ensure that vendor agreements include information on Consolidated Billing requirements. Update your policies and procedures as needed.
- Train all staff on the False Claims Act and what can be considered a false claim. Train appropriate staff on billing requirements under Medicare Part A consolidated billing rules upon hire and annually. Include information on how to report concerns and suspected violations, and that prompt reporting is mandatory. Ensure that vendor contracts or agreements require the vendor to bill the SNF for services to Medicare Part A residents, and not submit bills directly to Medicare B for services, unless they are specifically excluded. Document that the trainings occurred and place in each employeeās education file and in vendor agreement files.
- Periodically audit staff understanding and work practices to ensure that they are aware of what should be done if they suspect a false claim has occurred, whether intentionally or unintentionally. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to a false claim. Conduct periodic audits of Consolidated Billing transactions and related vendor billing submissions.
