Safe Harbor for Medical Transportation for Medicare/Medicaid Patients
Many healthcare providers do not know that free or discounted transportation may be legally provided to Medicare and Medicaid patients for medically necessary healthcare items and services. Typically, the provision of free or discounted transportation may implicate the Anti-Kickback Statute (AKS) or the Beneficiary Inducement Prohibition to the Civil Monetary Penalties Law (Beneficiary Inducement CMP); however, there are safe harbors and exceptions to those laws that healthcare providers may utilize to provide such transportation.
In 2016, the Office of the Inspector General (OIG) introduced a new safe harbor to the AKS allowing healthcare providers to provide transportation for “established” Medicare and Medicaid patients without violating the AKS. Patients may be considered “established” as long as they initiated contact to schedule an appointment with the provider.
Below is a summary of the key requirements of the safe harbor:
The availability of free or discounted transportation must be set forth in a policy, and cannot be determined in a manner related to the past or anticipated volume or value of Medicare or Medicaid patients;
The transportation provided must not involve air, luxury or ambulance-level transportation;
The provider must not publicly market or advertise the free or discounted local transportation services;
The transportation may only be provided to a provider’s “established patient”;
The transportation must be provided within a provider’s primary service area, which is identified as a certain radius from the provider’s location and may expand if the patient resides in a rural area; and
The provider must not shift the cost of the free or discounted transportation to any other person, entity, or payor.
The free or discounted transportation may be in the form of a shuttle service if certain conditions are met. Additionally, the OIG recently eliminated distance limitations for patients being discharged home from an inpatient facility, expanding providers’ ability to help patients transition after care.
In that same year, OIG also broadened certain exceptions to the Beneficiary Inducement CMP that may protect the same activity. As an example, providers may utilize the exception for items or services that promote access to care to provide free or discounted transportation to patients. Additional information on the AKS safe harbor and available exceptions to the Beneficiary Inducement CMP may found at https://oig.hhs.gov/compliance/safe-harbor-regulations/.
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*Please note that the above summary is for informational purposes only, and does not constitute legal advice. Please share with your legal advisor for assistance.*