As an owner of a BLS private transport company (Ambulance Only) I have several questions:1) Can an employer (me) pay an employee a bonus in exchange for business development activities where the payment received by the company is Medicare/Medicaid (ie or EMTs generate a new patient opportunity for dialysis)2) Can a provider of Medicare/Medicaid paid services have an internal policy for a class of patients (ie: we do not collect from patient any amount over and above the covered/paid amount from Medicare/Medicaid for transport...ie: we do not bill them the 20% left over after Medicare pays our billing. We are working on a policy where all dialysis transport patients would fall into this category)3) If a new employee of our company has developed a personal relationship based on repeated transports with a patient, is communication with that patient prohibited or is that contact information or knowledge of their dissatisfaction with their current provider HIPPA protected information? And also can that employee contact that patient via US Mail to let them know they have left the previous company to join our company based only on the positive attributes of our company. The bottom of that letter states to contact that employee or the CEO (me) with any additional questions about our services but there is also a disclaimer that the letter is not meant as a solicitation and should be filed if the patient is happy with their existing service)
Country relating to Question: United States
State (if USA): South Carolina
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I see that you have questions related to Medicaid and Medicare services.
Correct...we are a new company in our area and have recently hired away the top employees of a larger competitor who has a history of treating employees poorly as well as neglecting many of their patients
The federal Anti-Kickback Statute (AKS) (42 U.S.C.§1320a-7b(b)(1) and (2)), is a criminal law which prohibits payments for referrals where these federal dollars are involved.
they are now "throwing rocks"
Violations can result in jail sentences of up to five years, fines of $25,000 and penalties of up to $50,000 per violation.
As such, these are serious concerns.
It also states in section 3 that any amount paid by an employer to an employee is not covered correct? Section (3)
The same is true for offering discounted services to a particular group such as to patients of a dialysis clinic.
There is an employee exception.
There are a number of exceptions.
we DO NOT in any way compensate a patient, facility, etc...only pay our employees a commission based on generating the business
Because of the seriousness of violations it would be important to have an attorney draft a policy regarding any such payments and follow that policy exactly so as to not violated the law.
As for the coinsurance, are we required by law to bill the patient the difference between the Medicare allowable amount and the Medicare paid 80% of that amount?
I see. That is not an issue, but the law is complicated and caution should be taken. By constructing a detailed policy written by your attorney, you would reduce your risk of a violation.
Is it a specific group of patients?
For example, from a specific source such as a specific clinic?
I completely agree...should our corporate attorney be able to do that if they do not have Medicare/Medicaid experience specifically?
Yes. Any attorney should be able to review and research the law and draft a policy. If they have questions, they will know how to locate the answers or seek assistance.
NOT a specific clinic...is for ALL dialysis patients that we transport...our policy is to accept what their insurance pays period...we file on their behalf with all of their insurance companies and we accept what we get from those companies without charging them the difference if one exists...several of our competitors bill that amount, several do not
We currently transport into 4 different dialysis clinics owned by 3 different corporate entities
Our reasoning is that those patients represent 26 individual transports/month which obviously mean good revenue for our service but more importantly they could be accruing in excess of $1100/month for every month they are on dialysis...as many of these patients are indigent or on Permanent Disability, we make the decision to take the Medicare Reimbursement as sole payment
26 per patient per month
As to Medicare and Medicaid patients, waiving coinsurance is prohibited in the absence of a demonstration of financial hardship.
Documentation of such a hardship would need to be obtained.
ok...can you give me a reference in the statute on how to determine/verify/document hardship?
One second please
I have facilitated hundreds of hardship "letters" and packages in my past 10 years as a real estate broker but am sure there is something specific or a form that they may require if that is the case
In these instances, the law is broad and HHS OIG has issued opinion letters are permissible activities. I have located one that speaks to hospitals taking this approach and the information they must consider in determining financial hardship.
See page 3 and 4
With some research time, your attorney should be able to locate any revisions.
There are USC references in the footnotes as well, but the code is not precise in this subject and enforcement relies upon agency interpretation in policy.
btw, will I receive a record of this whole chat in my email when we are through?
That is a good question. Once you leave a rating, this will convert into a single viewable window at which time I always suggest the discussion be copied and pasted into your own document. This avoids any potential email issues such as the response going to a spam folder.
As to disclaimer language in a letter, that would need to be drafted by your attorney. Solicitation of clients is a concern and, in addition to federal law, state regulatory requirements should be checked.
Does the service hold a state license or contract?
the competiting service or our service?
the service DOES NOT have a contract with the patient however we develop of brief contract of services with the patient once they choose our service but it can be canceled at any time by any party
Dear Mrs. Williams,
This letter is to introduce the services of MedOne Lowcountry Medical Transport, LLC. We are a new private medical transport business based in Charleston, SC built with a focus on patient care, timely transport, and superior service at all points of the transport process.
I have made the choice to align myself with MedOne Lowcountry based on my faith in our ability and desire to become the provider of choice for BLS transport. I have been impressed and excited with all that is being done to ensure that medical personnel are outfitted with all of the tools, equipment, and management support necessary to provide the best transport choice for the Lowcountry and surrounding areas.
Management is committed to our patients and will be working hands-on with EMT personnel and drivers to ensure superior quality, response to the needs of patients and their families, and excellent follow up to track that quality through patient and facility satisfaction surveys.
If you would like to learn more about our dialysis transport services and how MedOne Lowcountry Medical Transport, LLC can become your new transport provider, please contact our office at XXX-XXX-XXXX at your earliest convenience.
I look forward to the opportunity to serve you!
All the best,
Josh Watts- CEO/Business Development Officer/XXX-XXX-XXXX
Disclaimer: This correspondence is not a solicitation for transport and should be used for informational purposes only. If you are satisfied with your current transportation provider, please file this letter and let us know if we can ever be of service should that change.
HHS has developed a compliance program for ambulance providers.
You can contact that agency to obtain those materials. An notice concerning the program was published in the federal register.
As to the letter, we are limited to providing information only due to site terms and bar requirements. I hope you understand that I am not permitted to actually provide an opinion about a letter or document.
That should be a relatively easy task for in-house counsel.
Do you have any other questions?
Was just showing as an example and completely understand
And by the way, simply by stating that a communication is not a solicitation does not mean that the letter does not solicit.
I think the last question is in regards XX XXXXXXX the relationship established by an employee with a patient while employed by one company is protected information as far as HIPPA is concerned
Can you elaborate on "relationship?" Do you mean can an employee of a company state person x was a patient to a third party without consent of the patient?
The answer would be no if that is the question.
No, as in, the information cannot be shared because it discloses confidential health information.
Identifying a person, by name or otherwise, and stating the person is a patient or received a medical service would not be permitted absent consent of the patient.
ex: XXXXX XXXXX is a dialysis patient that has been transported by XXXXX XXXXXX (EMT) for 2 years while Jason was an employee of CMC. During that time, patient expressed displeasure and disatisfaction with the services provided by CMC and they developed a relationship over that time that extended outside of work to include exchanging of personal cell phone numbers
XXXXX XXXXXX leaves CMC to go work for another company and informs Mr. Smith that he has done so
That is a slippery slope absent written consent.
So it is not necessarily the contact information that is HIPPA protected as much as the fact that Mr. Smith is a patient receiving medical care
so who would the patient grant consent to, the current company providing transport or Mr. Barnes EMT?
HIPAA would require consent for the disclosure of private patient information from the service provider.
When a patient provides their phone number to an employee of the service provider the question is whether that is information covered under HIPAA or not.
If it is within the scope of employment, it is safest to assume that it is covered.
Perhaps if it was outside of work and unrelated to any services being provided then the concerns would be lessened.
That makes sense I guess. So really absent that patient contacting us or the employee directly without us reaching out to them, we should not test that correct?
I can only suggest that you present the issue to your attorney for a comprehensive review because I cannot provide an opinion or advice. Only information can be provided; however, I hope that information is useful and you can apply it to your situation to draw your own informed conclusions.
If a blanket letter was sent to all residents of a facility as an example without regard to whether they were or were not identified as dialysis patients, would that be more appropriate? I know that we used to utilize similar methods in real estate as it was not considered direct solicitation in the same way that way that sending a letter to every active listing would be
OK...you have been very helpful overall and I appreciate your time
To identify residents of such a facility would be a potential violation, so I presume you means generically such as "current resident."
A "current resident" letter would not have any apparent HIPAA implications because there is no identification or personal information involved. The issue may be whether there are any solicitation restrictions. Some programs, either state or federal, have anti-solicitation restrictions. It could be possible, with a comprehensive research project to ensure that there are no such restrictions regarding solicitation in general.
sounds good...thank you
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Government and private sector employment law experience
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