Medicare Compliance & Reimbursement

Ambulance companies that charge an annual subscription fee in lieu of collecting Medicare Part B copays can avoid kickback sanctions from the HHS Office of Inspector General - if they know the ropes. That's clear from the OIG's latest advisory opinion (No. 03-11), which takes the measure of a subscription plan a non-profit ambulance services provider has been using since the early 1960s. The potential kickback risk in such arrangements, the OIG says, is that if the subscription fees are too low, the arrangement could amount to a routine waiver of Medicare Part B cost sharing amounts - a long-time fraud and abuse concern. In the arrangement under review, however, the aggregate subscription fees collected typically exceed the amount beneficiaries would be expected to spend on cost sharing. Given that fact, the opinion says, the OIG wouldn't subject the arrangement to kickback sanctions. To see the opinion, go to http://oig.hhs.gov/raud/docs/advisoryopinions/2003/ao0311.pdf. Lesson Learned: Ambulance companies who operate on a subscription basis should ensure that their programs don't appear to give beneficiaries a free ride on Part B cost sharing.