On Wednesday, December 7, 2016 the Department of Health and Human Services' Office of Inspector General released Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements final rule. You may wish to review the safe harbor established for "local transportation" and see if your scenario would fit. There is a proposed rule to expand that safe harbor under review now, with the comment period having closed on December 31, 2019.
I sincerely appreciate the guidance and feedback on my issue. I wasn't sure what to expect when I posed the question but thank you!I'm finding that much of the regulations out there are pretty gray on the matter because it is very circumstantial as some of you have pointed out. The only real reason for transfer is due to the lack of beds and I'm not sure what the medical necessity would be because its on a case to case basis. I was able to determine that there is patient choice in the matter and in this situation, none of chosen to go to the other system hospital as it is nearly an hour away compared to 15 minutes for the closest ED.My concern is naturally inducement and I agree that it certainly is a significant risk here. What's odd is regulations are fairly gray on the matter as it pertains to full beds, but as we all know if it doesn't feel right, it probably isn't right. I did explore safe harbors, but ambulances are not included in the safe harbor regulations unless owned or subsidized by the state government. These companies are independent of the system.I think I have a path I'm going to take and I appreciate everyone's input.
Again, nothing said will be taking as legal advice, guidance etc...Thanks!