The U.S. Department of Health and Human Services' Office of the Inspector General (HHS-OIG) created the compliance program guidance (CPG) for ambulance suppliers in 2003. The HHS-OIG oversees the Centers for Medicare and Medicaid Services and created this CPG in an attempt to prevent false claims and fraudulent activity in the ambulance industry.
Function
The CPG outlines common causes of fraud and abuse areas for ambulance providers. It instructs them address risk areas for fraud and abuse, prevent these instances from occurring and suggests methods for corrective actions when an ambulance provider identifies fraud and abuse.
Features
Compliance programs, which are voluntary for ambulance providers, have several components, including development of compliance policies and procedures, designation of a compliance officer, education and training programs, internal monitoring and reviews, and open lines of communication. The CPG also explains the difference between emergency and non-emergency transports, stating that Medicare covers ambulance services when a beneficiary's condition advises against the use of another form of transportation.
Warning
Medicare has identified several universal risks for ambulance provide and the HHS-OIG has included them in the CPG. Companies that provide ambulances identify additional risks specific to their organizations. The CPG does not include these additional risks as smaller companies will identify risks that do not affect larger companies and vice versa.
Tags: fraud abuse, additional risks