- Nine Florida hospitals will pay $6.2 million to settle allegations that they led ambulance companies to render and bill for medically unnecessary rides, said the U.S. Attorney's Office for the Middle District of Florida on Friday.
- Andrea Treese Berlin, senior counsel with the office of counsel to the HHS Inspector General, said that the settlement should serve as a warning to hospitals: Make sure you have appropriately-signed Certificates of Medical Necessity and Physician Certification Statements.
- Baptist Health, which owns four of the impacted hospitals, denied any wrongdoing and said the allegations unfairly put the onus on hospitals to be responsible for complying with ambulance company regulations.
"The Government suggests that hospitals should be 'gatekeepers' for ambulance reimbursement, but there are no laws or regulations that place such a burden on hospitals," Baptist said in a statement. "The Government's position essentially forces hospitals to become knowledgeable about complicated federal regulations applicable to ambulance companies. It puts the focus on reimbursement, not patient care."
Berlin's comments do seem to substantiate Baptist's assessment of where the responsibility lies:
"Hospitals need to educate their employees and contractors in regard to the documents they sign," Berlin said. "They need to make sure they understand the criteria to which they're certifying every time they sign one of these documents."
According to the feds, the nine hospitals provided Certificates of Medical Necessity for unnecessary rides between 2009 and 2014. While reimbursement went to the ambulance companies, the hospitals benefited indirectly from the freed-up beds, said assistant U.S. attorney Jason Mehta.
But what is a "medically necessary" ambulance ride? The crux of this case probably lies in one of the provisions of settlement: UF Health Jacksonville said in its statement that it has "agreed to provide additional guidance and education to employees involved in requesting ambulance services." Expect to see other hospitals carefully inspecting their ambulance policies.