Talking Medicare: DOJ Settlement Highlights Importance of Exclusion Testing

Talking Medicare: Recent DOJ Settlement Highlights Importance of Exclusion Testing On July 17, 2018, the U.S. Attorney for the District of Maine issued a press release on a settlement that had been reached with an ambulance service in Maine. As a result of this settlement, the ambulance service agreed to pay $16,776.74 to resolve allegations that it had submitted false claims to the Medicare and Maine Medicare Programs. While the Department of Justice’s press release referred to the matter as a civil health care fraud, that headline is somewhat misleading. The ambulance service was not alleged to “up-coded” its claims or to have billed for patients that did not require ambulance transportation. Rather, the ambulance service was accused of using monies paid to it by these federal health care programs to pay the salary and benefits of a woman hired to assist the company’s billing manager. The woman, who was not identified in news reports, had previously been excluded from participation in federal health care programs after surrendering her license as a pharmacy technician after being found to have inappropriately diverted certain controlled substances. The ambulance service apparently failed to conduct an exclusion test on this individual prior to placing...

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2017 AAA Legislative Awards

The American Ambulance Association is proud to announce the winners of the 2017 AAA Legislative Awards, in recognition of their strong advocacy for emergency medical services. Each legislator was chosen for their ongoing service to the ambulance services of the United States. 2017 AAA Legislator of the Year Senator Susan Collins (R-ME) – Press Release, Facebook Post, Twitter Post 2017 AAA Legislative Recognition Award Recipients Senators Sen. Richard Burr (R-NC) – Press Release Sen. Bill Cassidy (R-LA) – Press Release Sen. Orrin Hatch (R-UT) – Press Release Sen. Patrick Leahy (D-VT) – Press Release Sen. Pat Roberts (R-KS) – Press Release Sen. Charles Schumer (D-NY) – Press Release Sen. Debbie Stabenow (D-MI) – Press Release Sen. Jon Tester (D-MT) Sen. Ron Wyden (D-OR) – Press Release Representatives Rep. Kevin Brady (R-TX) – Press Release Rep. Mike Coffman (R-CO) – Press Release Rep. Gregg Harper (R-MS) Rep. Richard Hudson (R-NC) – Press Release Rep. Kenny Marchant (R-TX) Rep. Markwayne Mullin (R-OK) Rep. Richard Neal (D-MA) Rep. Devin Nunes (R-CA) – Press Release Rep. Erik Paulsen (R-MN) Rep. Peter Roskam (R-IL) – Press Release Rep. Mike Thompson (D-CA) Rep. Pat Tiberi (R-OH) – Press Release Rep. Fred Upton (R-MI) Rep. Greg Walden (R-OR) Rep. Peter Welch (D-VT)...

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Senator Susan Collins Named Legislator of the Year

For Immediate Release Senator Collins To Receive Highest Legislative Honor from American Ambulance Association To Be Recognized as AAA Legislator of the Year Contact Amanda Riordan 703-610-9018 ariordan@ambulance.org www.ambulance.org Washington, D.C. – The American Ambulance Association (AAA) has named Senator Susan Collins of Maine as the AAA Legislator of the Year, in recognition of her strong advocacy for emergency medical services. Senator Collins is invited to receive this honor at the AAA’s annual Stars of Life recognition ceremony on June 13 in Washington, D.C. The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life pays tribute to the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 101 EMS professionals will be honored as 2017 Stars of Life. In addition to Senator Collins’s recognition as as Legislator of the Year, twenty-four United States Senators and Representatives will receive Legislative Recognition Awards for their support of ambulance services. AAA President Mark Postma notes, “Senator Collins has been a tireless advocate for emergency medical services, both in Maine and (more…)

ACHA Update – High-risk Pool Amendment

The House Rules Committee met last week to consider a new amendment to the American Health Care Act (AHCA) to establish a federal risk-sharing fund and appropriate $15 billion for a high-risk pool program from 2018 to 2026. The amendment, which aims to reduce premiums for those with pre-existing conditions, is sponsored by Reps. Gary Palmer (R-AL) and Dave Schweikert (R-AZ), both members of the House Freedom Caucus. Washington Post: “GOP House leaders say health bill tweak shows progress, but larger divisions remain“ The program is reportedly modeled after a successful initiative in the State of Maine. The federal government would run the program initially, but each state will have the ability to take over the high-risk pool after three years. The amendment represents one area of limited agreement in the broader AHCA debate. Conservative House Members are likely to support it to the extent it shifts authority and funding to the states to help keep premiums down, and moderates are likely to support it because it would add a layer of protection for individuals with pre-existing conditions. It is unclear whether the level of funding appropriated will be sufficient to meet the need, however. The development is not evidence...

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Status of the American Health Care Act

Today, citing “growing pains” of his Republican majority, Speaker Paul Ryan (R-WI), in consultation with President Donald Trump, determined not to proceed with a planned vote on the American Health Care Act (AHCA), which repealed and replaced important elements of the Affordable Care Act (ACA).  The Speaker indicated that the House Republican Caucus “came up short” in the number of votes needed for the bill.  House Republican Leadership had been moving AHCA through the Chamber at a rapid pace.  The bill was officially released on March 6, and had been changed several times to try to appease various conservative and moderate voting blocs within the Republican Caucus.  The Congressional Budget Office (CBO) originally estimated the bill would reduce federal deficits by $337 billion, and subsequently downgraded the deficit reduction to $150 billion based on additional substantive policy changes to the bill.  The CBO estimates the bill would have increased the country’s number of uninsured by about 24 million people. In negotiating the provisions of AHCA, the House Republican Leadership had faced a constant seesaw, as efforts to appease one ideological bloc upset the other.  Ultimately, throughout the day in advance of the scheduled vote, an increasing number of moderate Republicans,...

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House Holds Hearing on Veterans Choice Program

The House VA Committee hearing started at 7:30 p.m., but it was well-attended and lasted until 10 p.m. The witnesses included Senator John McCain (R-AZ), VA Secretary David Shulkin, and representatives of the VA Office of Inspector General and the Government Accountability Office. Senator McCain and Secretary Shulkin were both warmly welcomed by Members of the Committee on a bipartisan basis. Chairman Roe (R-TN) emphasized the need to act quickly to extend the authorization for the Veterans Choice Program, which expires on August 7. To that end, the House VA Committee is voting today on a bill to eliminate the sunset of the program’s authorization. In addition, the Committee will consider broader legislation later this year to make comprehensive reforms to the Choice Program. He noted that the VA has additional funds available but will not be able to spend them once the authorization expires. A copy of Chairman Roe’s opening statement is available here. Secretary Shulkin testified in support of extending the Choice Program, and he clarified that the VA was not seeking additional funding – just the authority to spend funds already obligated. He noted that the VA already is being forced to deny Choice Program coverage to...

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2015 Medicare Data Shows Evident of Crackdown on Non-Emergency Transport

2015 Medicare Payment Data Offers Evidence of Nationwide Crackdown on Non-Emergency Ground Ambulance Transportation; Impact Varies Dramatically by Medicare Administrative Contractor Every year, CMS releases data on aggregate Medicare payments for the preceding year. This file is referred to as the Physician/Supplier Procedure Master File (PSP Master File). This past month, CMS released the 2016 PSP Master File, which contains information on all Part B and DME claims processed through the Medicare Common Working File with 2015 dates of service. In September’s blog post, I discussed the results of the first year of the prior authorization demonstration project for repetitive, scheduled non-emergency ground ambulance transports. During this first year, the project was limited to three states: New Jersey, Pennsylvania, and South Carolina. The data confirms that these three states saw a dramatic reduction in Medicare’s approved payments for dialysis transports. This month, I will be discussing the national payment trends for non-emergency ground ambulance transports, and, in particular, Basic Life Support non-emergencies. In 2015, Medicare paid approximately $990 million for BLS non-emergency transports. This is 13% less than what it paid for BLS non-emergency transports in 2014 ($1.14 billion). Please note that these figures only reflect payments for the base...

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Senator Scott Receives 2015 AAA Legislative Recognition Award

Pictured is Senator Tim Scott (R-SC) receiving a 2015 AAA Legislative Recognition Award from Greg Shore of AAA member Medshore Ambulance Service in Andersen, South Carolina. Included in the picture is Senator Susan Collins (R-ME) who is one of the lead sponsors of the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377, H.R. 745).