Non-Emergency Transport: Avoiding the Fraud Trap [Sponsored]

By Eric van Doesburg, MP Cloud Technologies This sponsored post is not endorsed by the American Ambulance Association. It reflects the views of the author. Did you know that one of the most common practices in our industry could put your company at financial risk? Transporting patients not qualified for ambulance transportation is a hot topic these days as it has heavily contributed to the rise of Medicare fraud cases. This issue has grown even more relevant recently with a case in Florida, where not only was the EMS company found liable of fraud, but it was the first time several hospitals were held culpable as well.¹ While the burden of proof falls on the government to satisfy the statutes in the Federal False Claims Act, the fact is investigators are becoming more aggressive in fighting these types of billing schemes. “The fact is investigators are becoming more aggressive in fighting these types of billing schemes.” Yes, there are some bad actors in our industry like any other, but more times than not employees simply may be unaware of the qualifications needed when dispatching non-emergency transport. Thankfully, a company can protect its financial future simply by having the necessary protocols (more…)

HHS OIG Issues Advisory Opinion on Community Paramedicine

HHS OIG Issues Advisory Opinion Permitting Community Paramedicine Program Designed to Limit Hospital Readmissions On March 6, 2019, the HHS Office of the Inspector General (OIG) posted OIG Advisory Opinion 19-03. The opinion related to free, in-home follow-up care offered by a hospital to eligible patients for the purpose of reducing hospital admissions or readmissions. The Requestor was a nonprofit medical center that provides a range of inpatient and outpatient hospital services. The Requestor and an affiliated health care clinic are both part of an integrated health system that operates in three states. The Requestor had previously developed a program to provide free, in-home follow-up care to certain patients with congestive heart failure (CHF) that it has certified to be at higher risk of admission or readmission to a hospital. The Requestor was proposing to expand the program to also include certain patients with chronic obstructive pulmonary disease (COPD). According to the Requestor, the purpose of both its existing program and its proposed expansion was to increase patient compliance with discharge plans, improve patient health, and reduce hospital inpatient admissions and readmissions. Under the existing program, clinical nurses screen patients to determine if they meet certain eligibility criteria. These include...

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HIPAA Breach Results in Highest Settlement in OCR History

The U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) announced earlier this month that is has entered into the largest settlement agreement in the history of the Department with Anthem, Inc., the largest Blue Cross and Blue Shield health benefit companies in the country.  Anthem, Inc. agreed to pay $16 million to HHS and take substantial corrective action to settle numerous potential violations of both HIPAA Privacy and Security Rules after it exposed protected health information (PHI) for nearly 79 million people. In March 2015 Anthem filed a breach report with OCR after they discovered that their Information Technology (IT) systems were infiltrated by cyber-attackers who had gained access to their systems after an Anthem employee opened a phishing email.  This email released an undetected continuous persistent threat attack that permitted the cyber-attackers to access their systems from December 2014 through the end of January 2015.  This attack opened access that ultimately resulted in the PHI of nearly 79 million people to be stolen. OCR’s investigation revealed that Anthem failed to conduct an enterprise-wide risk analysis.  Additionally, OCR determined that Anthem “failed to have sufficient policies and procedures to regularly review IT system activity, identify...

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Notice of Proposed Change to OSHA Injury Reporting

Notice of Proposed Change to OSHA Electronic Injury Reporting Regulations The Occupational Safety and Health Administration (OSHA) announced on July 27, 2018 that it has published a Notice of Proposed Rulemaking (NPRM) that would change the Electronic Injury Reporting Regulations (29 CFR Part 1904) for employers with 250 or more employees. OSHA is proposing this change due to a heightened concern that employee Personally Identifiable Information may be at risk of disclosure through the Freedom of Information Act (FOIA). Currently, all EMS employers must submit their annual injury and illness data to OSHA through the Injury Tracking Application (ITA). Historically, employers were required to track all workplace injuries and illnesses and maintain records of those incidents in the workplace on the OSHA Form 300, 301, and 300A. Each year, employers are required to post a Summary of Workplace Injuries and Illnesses on the Form 300A from February 1st through April 30th. In May 2016, OSHA amended the regulations requiring all employers to submit their Form 300A Summary electronically through the Injury Tracking Application (ITA). Employers with 250 or more employees were required to electronically report all injury and illness data from Forms 300, 301, and 300A each year. Initially OSHA...

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Data Privacy

This past January, the AAA hosted a webinar presented by EMS/healthcare Attorneys Matthew Streger, Margaret Keavney, and Rebecca Ragkoski, titled Cybersecurity, Top 10 Considerations in Healthcare and How to Address Them. During this very informative webinar, Matt, Margaret, and Rebecca covered one of the biggest issues facing EMS and other healthcare providers today, data security. If you did not get chance to listen in on this program, it is available on-demand at the AAA website. As highlighted in their webinar, data security and data breach concerns are one of the most frequently encountered issues facing EMS agencies as healthcare providers but also as employers. Ensuring that patient and employee protected health information (PHI) and personally identifiable information (PII) is adequately protected from access or intrusion is critically important. Alabama becomes the 50th state to enact data breach requirements for all individuals and businesses in the state. The Society for Human Resource Management (SHRM) provides a great summary of the new breach requirements in several article resources published this week. The National Conference on State Legislatures is a great resource for learning the laws that apply to your organization. Of course, it is recommended that all members engage a law firm...

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OSHA Injury Reporting

Last year we notified AAA members that they must begin electronically reporting their workplace injury data to OSHA starting December 1, 2017 for 2016. This is just a reminder to all employers can begin electronically reporting their 2017 workplace injury data through the OSHA Injury Tracking Application (ITA). 2017 Injury Data must be submitted to OSHA no later than July 1, 2018. For employers in states that are covered by OSHA approved state level work injury regulations, OSHA has announced on April 30, 2018 that employers in states that have not completed the adoption of a state rule must also report their 2017 injury data through the OSHA ITA. If any member has not set up their account with OSHA on the ITA, we strongly suggest that you do so immediately. The AAA can assist members who need assistance ensuring they are compliant with this reporting requirement....

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Recovering Loss of Revenue from “not at fault” Accidents

When your units get hit by a third party and the vehicle is out of service, are you getting Loss of Revenue for the downtime while the unit is being repaired? Whether you answered yes or no to that question, reading this article will be the one of the most lucrative uses of your time this year. A call comes in and your dispatcher does a perfect job of answering and scheduling the run. The EMT’s jump into the clean, fueled, and well stocked ambulance responding to the call. Then from out of nowhere, a car turns directly into the ambulance’s path rolling through a stop sign. Now what? You have two paramedics stranded on the side of the road who will be spending the next few hours on paperwork and drug testing. In addition, all the drugs and small equipment need to be removed or secured. Hopefully you have another unit to dispatch or your competitor may have already been called. What happens next is key to getting maximum recovery for your losses caused by the accident. Key items that help maximize your recovery from accidents: Educate and equip fleet drivers with the tools necessary to collect key accident...

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Family Liaisons Following EMS Line of Duty Deaths

I was just a kid when I started in EMS. 23 years old, hungry for adventure, and ready for everything the world of EMS was prepared to give me. Car accidents, gunshot wounds, stabbings, intoxicated shenanigans, elderly falls, fist fights, medical emergencies, strokes, and cardiac arrest were all on my list of expected possibilities. One of the scenarios I had not thought of, and nobody presented to me throughout school and orientation, was the possibility of clocking in for shift and not going home. I do not recall line of duty deaths being a discussion point in the paramedic curriculum, job interview, or orientation process. I had experienced the unexpected loss of a younger sibling due to a motor vehicle crash before I started my journey in EMS, but the fact that life is short and unpredictable did not connect with the fact that I was knowingly and willingly walking myself into unknown and potentially dangerous situations with each response. Even after the UW Med Flight crash happened early in my career, and in my service area, we simply did not talk about our own potential for death as a direct result of our profession. Years later, after many more...

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