The Office of Inspector General (OIG) recognizes that, in the present public health emergency resultant from the outbreak of the COVID-19, the health care industry must focus on delivering required treatment to patients. Let’s discuss in more detail about Cost-Sharing Obligations Updates.
OIG’s Part in Cost-Sharing Obligations
As part of OIG’s mission to encourage economy, efficiency, and effectiveness in HHS programs, CMS is committed to protecting patients by confirming that health care providers have the regulatory flexibility required to appropriately answer to COVID-19. As a result, OIG is accepting inquiries from the health care community about the appliance of OIG’s administrative enforcement authorities, including the Federal AKS and civil monetary penalty (CMP) provision prohibiting inducements to beneficiaries.
Do you have a question regarding how OIG would view a preparation that is directly linked to the public health emergency and implicates these authorities, you can now email your question to OIG Compliance. While you submit your questions, please provide sufficient facts to permit for an understanding of the key parties and terms of the arrangement in dispute. OIG answers are openly available through frequently asked questions (FAQ) posting on the OIG COVID-19 portal.
Cost-Sharing Obligations Waiver FAQ
What are the consequences, under OIG’s administrative sanction authorities, of an ambulance provider or supplier waiving or write off beneficiary cost-sharing obligations resulting from ground ambulance services paid for by the Medicare program under a waiver established pursuant to section 1135 (b) (9) of the Social Security Act?
OIG responded that the ambulance provider or supplier waiving or write off beneficiary cost-sharing obligations resulting from ground ambulance services paid for by the Medicare program under a waiver established pursuant to section 1135 (b) (9) of the Social Security Act would implicate the Federal anti-kickback statute and Beneficiary Inducements CMP.
Generally, an ambulance provider waiving beneficiary cost-sharing obligations implicates the AKS and the beneficiary inducement CMP. According to Ambulance Fee Schedule, 80% of the approved amount paid by Medicare Part B, and for the remaining 20% as well as the applicable Part B deductible the beneficiary is responsible.
The government is interested to know that providers waving the co-payment amount will be incentivized from the provider so that patients can receive further covered services. OIG believes that such co-payments waivers and incentives have a sufficiently low risk of fraud and abuse. OIG will not need ground ambulance providers to accumulate beneficiary cost-sharing before they claim Medicare bills for such services.
Currently, each state, local and municipal authorities established communitywide EMS protocols requiring or allowing ambulance providers and suppliers to treat certain patients, including Medicare beneficiaries, “in place” who otherwise, but for the pandemic, would have been transported to a Medicare-covered destination.
Routine waivers of cost-sharing obligations implicate the Federal anti-kickback statute and therefore the civil monetary penalty provision prohibiting inducements to beneficiaries and should end in overutilization or inappropriate utilization of things and services reimbursable by Federal health care programs.
In light of those EMS protocols, on May 5, 2021, pursuant to section 1135(b)(9) of the Social Security Act, the Secretary of Health and Human Services waived certain statutory requirements concerning to Medicare payments for ground ambulance services furnished in response to a 911 call. Generally, Medicare billing requires such type of transportation before a ground ambulance provider can get Medicare reimbursement.
According to HHS, the FAQ is a complimentary answer related to ambulance providers and suppliers waiving or write off beneficiary cost-sharing obligations causing from ground ambulance services reimbursed for under the CMS waiver that waives certain statutory necessities relating to Medicare payment for ground ambulance services.