Generally, an ambulance provider waiving beneficiary cost-sharing obligations implicates the AKS and the beneficiary inducement CMP.

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Ambulance Transport Waiver – Cost-Sharing Obligations Updates
The Office of Inspector General (OIG) recognizes that, in the present public health emergency resultant from
the outbreak of the COVID-19, the health care industry must focus on delivering required treatment to
patients.
OIG’s Part in Cost-Sharing Obligations
As part of OIG’s mission to encourage economy, efficiency, and effectiveness in HHS programs, CMS is
committed to protecting patients by confirming that health care providers have the regulatory flexibility
required to appropriately answer to COVID-19. As a result, OIG is accepting inquiries from the health care
community about the appliance of OIG’s administrative enforcement authorities, including the Federal AKS
and civil monetary penalty (CMP) provision prohibiting inducements to beneficiaries.
Do you have a question regarding how OIG would view a preparation that is directly linked to the public
health emergency and implicates these authorities, you can now email your question to OIG Compliance.
While you submit your questions, please provide sufficient facts to permit for an understanding of the key
parties and terms of the arrangement in dispute. OIG answers are openly available through frequently asked
questions (FAQ) posting on the OIG COVID-19 portal.

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Ambulance Transport Waiver – Cost-Sharing Obligations Updates
Cost-Sharing Obligations Waiver FAQ
What are the consequences, under OIG’s administrative sanction authorities, of an ambulance provider or
supplier waiving or write off beneficiary cost-sharing obligations resulting from ground ambulance services
paid for by the Medicare program under a waiver established pursuant to section 1135 (b) (9) of the Social
Security Act?
OIG responded that the ambulance provider or supplier waiving or write off beneficiary cost-sharing
obligations resulting from ground ambulance services paid for by the Medicare program under a waiver
established pursuant to section 1135 (b) (9) of the Social Security Act would implicate the Federal anti-
kickback statute and Beneficiary Inducements CMP.
Generally, an ambulance provider waiving beneficiary cost-sharing obligations implicates the AKS and the
beneficiary inducement CMP. According to Ambulance Fee Schedule, 80% of the approved amount paid by
Medicare Part B, and for the remaining 20% as well as the applicable Part B deductible the beneficiary is
responsible.

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Ambulance Transport Waiver – Cost-Sharing Obligations Updates
The government is interested to know that providers waving the co-payment amount will be incentivized
from the provider so that patients can receive further covered services. OIG believes that such co-payments
waivers and incentives have a sufficiently low risk of fraud and abuse. OIG will not need ground ambulance
providers to accumulate beneficiary cost-sharing before they claim Medicare bills for such services.
Currently, each state, local and municipal authorities established communitywide EMS protocols requiring or
allowing ambulance providers and suppliers to treat certain patients, including Medicare beneficiaries, “in
place” who otherwise, but for the pandemic, would have been transported to a Medicare-covered
destination.
Routine waivers of cost-sharing obligations implicate the Federal anti-kickback statute and therefore the civil
monetary penalty provision prohibiting inducements to beneficiaries and should end in overutilization or
inappropriate utilization of things and services reimbursable by Federal health care programs.
In light of those EMS protocols, on May 5, 2021, pursuant to section 1135(b)(9) of the Social Security Act, the
Secretary of Health and Human Services waived certain statutory requirements concerning to Medicare
payments for ground ambulance services furnished in response to a 911 call. Generally, Medicare billing
requires such type of transportation before a ground ambulance provider can get Medicare reimbursement.

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Ambulance Transport Waiver – Cost-Sharing Obligations Updates
According to HHS, the FAQ is a complimentary answer related to ambulance providers and suppliers waiving
or write off beneficiary cost-sharing obligations causing from ground ambulance services reimbursed for
under the CMS waiver that waives certain statutory necessities relating to Medicare payment for ground
ambulance services.
To know more about Ambulance Transportation billing services, contact us
at info@medicalbillersandcoders.com / 888-357-3226.