Ambulance supplier's payment proposal could violate anti-kickback statute

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One ambulance supplier's proposal to receive payments from skilled nursing facilities that use Medicaid transport services could overstep the bounds of an anti-kickback statute, according to an advisory opinion from the Department of Health and Human Services' Office of Inspector General.

The supplier had previously been paid for driving services under the state Medicaid program, which used a set fee schedule, the Bureau of National Affairs reported. But a change to state law rendered transport services as ancillary support costs, which states pay SNFs on a per-resident-per-day basis. Now, SNFs will compensate ambulance suppliers directly with negotiated rates.

The ambulance supplier proposed two payment plans for OIG consideration. Under the first plan, the ambulance supplier would offer SNFs a capitated rate per resident for Medicaid transport services based on resident days, rather than whether a patient requires the services, BNA said. Under the second payment plan, the ambulance supplier would offer a SNF a contract under which the facility would pay for transport services for Medicaid patients on a fee-for-service basis.
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