Mr. Fairlie is again a featured contributor to the "Legal Corner" in this month's EMS Connections magazine. You can read his thoughts on the future of regulatory oversight for EMS Agencies and find the full article at EMS Connections
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Fairlie Law Managing Member, Kevin Fairlie, will be speaking again at the nation's leading conference for EMS leaders. Mr. Fairlie will be presenting at two Pinnacle Power Seminars: "What you Don't Know Can Hurt You: How to Manage Regulatory and Other Investigations" and "Bending the Curve to Achieve Financial Sustainability." You can find more information about the renowned Pinnacle EMS conference at their website here.
On December 22, 2016, MMAC issued a Memo indicating that it will begin conducting onsite audits to determine whether information provided during provider enrollment is accurate. MMAC stated that it would conduct audits for providers it classifies as Moderate or High risk to the Missouri Medicaid program. Missouri Ambulance Providers are listed as moderate risk entities by MMAC. Therefore, Missouri Ambulance Providers should be reviewing their Medicaid enrollment and revalidation information and take steps to ensure that information provided to MMAC is correct.
If you have questions on this process, please contact the firm for further assistance. You may contact Kevin Fairlie directly here This is a great event in support of a wonderful cause and a wonderful organization. More information at the event website.
Founding Member, Kevin Fairlie, authors a new article at www.EMS1.com
Health care providers of all shapes and sizes have seen an increase in Medicare and Medicaid payment audits after the implementation of the Affordable Care Act and its many provisions for safeguarding Medicare and Medicaid. The Office of the Inspector General at the U.S. Department of Health and Human Services says the Centers for Medicare & Medicaid Services should increase monitoring of ambulance billing. Here is what increased monitoring will look like and how it will impact EMS agencies. Increased audits EMS agencies should expect audits to increase in frequency and complexity. A September 2015 study released by the OIG found that roughly 1 in 5 ambulance providers had questionable billing practices. The study recommended that CMS increase its monitoring of ambulance billing. This will come in the form of billing audits in which EMS agencies will be required to justify, through appropriate documentation, that their claims are legitimate. If agencies cannot, they will face potentially large paybacks — returning Medicare and Medicaid payments. Read the full article here The Centers for Medicare & Medicaid Services (CMS) extended the temporary moratoria on the enrollment of new Medicare Part B ground ambulance suppliers in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey. This is a 6 month extension. CMS stated that it extended the moratoria based on a high risk of fraud, waste, or abuse in these provider and supplier types within those geographic locations. The information was posted February 2nd in the Federal Register and can be found here. Continued crack down on Medicare fraud and EMS providers. This one is somewhat unusual in that management level individuals and not just the owners were sentenced to prison. Once again, this involved billing for medically unnecessary transportation.
Full DOJ press release here http://www.justice.gov/opa/pr/southern-california-ambulance-company-owner-operator-and-managers-sentenced-prison-medicare OIG publishes new report reinforcing its scrutiny on ambulance transport fraud and abuse.9/29/2015 It's not new news to people in the industry but this is a strong message that the OIG is focusing on EMS agencies now more than ever. The report finds that ambulance claims paid by Medicare doubled from 2003 to 2012. Effective corporate compliance programs remain critical to EMS agencies.
See the report here: Inappropriate Payments and Questionable Billing for Ambulance Transports The firm founding Principal, Kevin Fairlie, is an invited speaker at the Pinnacle EMS Leadership Conference being held at the Omni Plantation Amelia Island Resort in Florida from August 3-7, 2015. Mr. Fairlie will be presenting at two separate sessions where he will advise the nation's EMS leaders on issues involving the largest risk areas for EMS leaders and companies as well as providing expertise on how to handle major government investigations. This is a link to the Pinnacle Program and Mr. Fairlie's topics: www.pinnacle-ems.com/program/?faculty=kevin-fairlie-jd |
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