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Ambulance billing for Medicare: Watch out for these federal regulations

On Behalf of | Jun 25, 2024 | Stark Law/Anti-Kickback Statutes |

Ambulance services play an important role in healthcare, ensuring timely transportation for patients in need but billing for these services can be complex. Ambulance companies must comply with various federal regulations. A failure to do so can result in serious consequences. Two of the more common applicable regulations include the following.

#1: The Anti-Kickback Statute (AKS)

Ambulance companies must generally comply with the Anti-Kickback Statute (AKS), which prohibits offering, paying, soliciting, or receiving anything of value in exchange for referrals or business related to federal healthcare programs (including Medicare and Medicaid).

Violations can lead to criminal penalties, fines, and exclusion from federal programs.

#2: False Claims Act (FCA)

The FCA prohibits knowingly submitting false claims for payment to the government. Ambulance companies must ensure accurate billing information to avoid FCA liability.

Ambulance providers must meet specific conditions to participate in the Medicare program. These include maintaining proper documentation, ensuring medically necessary services, and following billing guidelines.

The government often pairs the two regulations together and may move forward with charges for violation of both healthcare laws. In a recent example, the US Attorney’s Office has accused an ambulance company out of New York of violating both the AKS and the FCA when it provided patients with transportation to medical appointments. The government has moved forward with charges and claims to have evidence the company billed for services that were not provided because the alleged patient was either deceased or incarcerated at the time of transport.

Those involved will need to review the charges and build a defense to the allegations. This could include demonstrating that the company did not submit a false claim or otherwise gather evidence to refute the government’s allegations. It is important those who run ambulance services understand the intricacies of ambulance billing to reduce the risk of allegations of a violation of federal regulations.

Attorney John Rivas is responsible for this communication.

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