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Expect more oversight of EMS billing through post-payment audits and increased investigations, prosecution
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.
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.
Fairlie Law Managing Member, Kevin Fairlie, contributes article on the OIG and increased federal oversight of EMS billing - published today in Paramedic Chief at EMS1.com
DOJ successfully prosecutes not only the owners and operators but also the managers of a California ambulance company sending them all to prison.
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
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