Emergency Medical Services: Let`s Make a Deal?

Some of you may be familiar with the TV game show Let's Make a Deal, currently hosted by Wayne Brady (originally hosted by Monty Hall, for some of our more-senior members). Show contestants have to decide whether the deal they have is worth risking for a potentially better deal. The risk involves getting a "zonk," which is usually an item of little or no value.

For years, fire-based EMS agencies had "deals" with hospitals, private ambulance companies and others to restock medications and supplies at no cost and receive services for free or at greatly reduced costs, with freebies offered as enticements to bring patients to a specific facility.

Then along came the Federal Anti-Kickback Statute (AKS), prohibiting ambulance and healthcare providers from offering anything of value (discounts, gifts, etc.) to have Medicare and Medicaid patients referred to them. The law carries with it fines up to $50,000 per violation and up to five years in jail. Not wanting to violate a federal law, providers and hospitals quickly scrapped the variety of deals that had been in place.

Over the years, creativity has allowed new deals, especially for nontransport, fire-based EMS agencies. It's not uncommon for fire departments to contract with private ambulance companies with language that includes a fee paid to the fire department for transports, free or reduced-cost EMS classes and CEs for fire department members, free transports for agency employees or replacement of EMS supplies used on scene.

These types of requirements have been included prominently in the requests for proposals when contracts have been up for bid, and fire departments have benefitted greatly.

The Office of the Inspector General (OIG) has now determined that these deals are in potential violation of the AKS according to Advisory Opinion 13-18, issued in November 2013. The OIG wrote this opinion after an ambulance provider requested a review of an RFP where a number of free or reduced items were included as part of the requirements. The OIG suggested that even though the ambulance provider was attempting to mitigate certain requirements to ensure they weren't violating AKS, the overall appearance of the RFP was that both entities risked violating this federal law.

I strongly encourage all of our fire-based EMS members who have contracts for ambulance service to review Advisory Opinion 13-18 (PDF) in relation to your current contracts. In just a few of the contracts I'm aware of, it seems very probably that there are violations of the law based on this opinion.

If you find potential violations, they should be corrected immediately. The risk isn't worth the penalty. Ultimately, what you don't want is to play Let's Make a Deal with the federal government. Doing so will more than likely ensure that you'll end up with a zonk.

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