[Federal Register Volume 65, Number 160 (Thursday, August 17, 2000)]
[Notices]
[Pages 50204-50205]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-20856]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of Inspector General


Solicitation of Information and Recommendations for Developing a 
Compliance Risk Guidance for the Ambulance Industry

AGENCY: Office of Inspector General (OIG), HHS.

ACTION: Notice.

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SUMMARY: This Federal Register notice seeks the input and 
recommendations of interested parties as the OIG develops a Compliance 
Risk Guidance (CRG) for ambulance service providers, especially those 
serving Medicare, Medicaid and other Federal health care program 
beneficiaries. The ambulance industry has experienced a number of 
instances of ambulance provider and supplier fraud and abuse and has 
expressed interest in increasing the awareness of the industry to 
assist in protecting against such conduct. In response to the 
industry's concerns, the OIG has, to date, written seven Advisory 
Opinions on a variety of ambulance-related issues \1\ and has published 
a proposed rule concerning a safe harbor for ambulance restocking.\2\
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    \1\ See Advisory Opinions Nos. 97-6, 98-3, 98-7, 98-13, 99-1, 
99-2 and 99-5. The Advisory Opinions can be found on the OIG web 
site at 
http://www.hhs.gov/oig.
    \2\ See 65 FR 32060; May 22, 2000.
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    In an effort to provide further guidance, the OIG is soliciting 
comments, recommendations and other suggestions from concerned parties 
and organizations on how best to develop an ambulance CRG to reduce the 
potential for fraud and abuse. The OIG expects that the CRG will 
outline the most common and prevalent fraud and abuse risk areas for 
the ambulance industry. In addition, the CRG will provide guidance on 
how to: (1) Address these risk areas; (2) prevent the occurrence of 
instances of fraud and abuse; and (3) develop corrective actions when 
those risks or instances of fraud and abuse are identified.
    The OIG expects that the risk areas identified in the CRG will not 
be all-inclusive. Ambulance providers and suppliers will remain 
responsible for identifying those risk areas particular to their 
specific operations.

DATES: To assure consideration, comments must be delivered to the 
address provided below by no later than 5 p.m. on October 16, 2000.

ADDRESSES: Please mail or deliver your written comments, 
recommendations and suggestions to the following address: Department of 
Health and Human Services, Office of Inspector General, Attention: OIG-
1-CRG, Room 5527 A, Cohen Building, 330 Independence Avenue, S.W., 
Washington, D.C. 20201.
    We do not accept comments by facsimile (FAX) transmission. In 
commenting, please refer to the file code OIG-1-CRG. Comments received 
timely will be available for public inspection as they are received, 
generally beginning approximately 3 weeks after publication of a 
document, in Room 5541 of the Office of Inspector General at 330 
Independence Avenue, S.W., Washington, D.C. 20201 on Monday through 
Friday of each week from 8 A.M. to 4:30 P.M.

FOR FURTHER INFORMATION CONTACT: Sonya Castro, Office of Counsel to the 
Inspector General, (202) 619-2078.

SUPPLEMENTARY INFORMATION: The contents of this CRG will differ from 
the previous OIG compliance program guidances.\3\ Although the CRG will 
refer to the seven elements of establishing an effective compliance 
program, set forth in the previous compliance program

[[Page 50205]]

guidances,\4\ the CRG will concentrate on specific identified risk 
areas and related compliance program best practices.
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    \3\ The OIG has issued compliance program guidance for the 
following eight industry sectors: hospitals, clinical laboratories, 
home health agencies, durable medical equipment suppliers, third-
party medical billing companies, hospices, Medicare+Choice 
organizations offering coordinated care plans and nursing 
facilities. Additionally, the Individual and Small Group Physician 
Practice Compliance Program Guidance has been issued in draft form 
(June 12, 2000; 65 FR 36818). The Compliance Program Guidances can 
be found on the OIG web site at http://www.hhs.gov/oig in the 
Electronic Reading Room, or by calling the OIG Public Affairs office 
at (202) 619-1343.
    \4\ The seven elements of an effective compliance program 
include: (1) The development of written policies and procedures; (2) 
the designation of a compliance officer and other appropriate 
bodies; (3) the development and implementation of effective training 
and education programs; (4) the development and maintenance of 
effective lines of communication; (5) the enforcement of standards 
through well-publicized disciplinary guidelines; (6) the use of 
audits and other evaluation techniques to monitor compliance; and 
(7) the development of procedures to respond to detected offenses 
and to initiate corrective action.
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    The CRG will include an additional section relating to risk areas 
associated with the Medical Assistance or Medicaid program 
requirements. The OIG intends to broadly address the Medicaid risks in 
light of the fact that the coverage and reimbursement rules differ 
among the various Medicaid programs. In order for the OIG to adequately 
incorporate the most prevalent Medicaid risk areas, we are requesting 
comments and suggestions from the various State agencies providing 
Medicaid services and from those ambulance providers and suppliers that 
furnish a significant level of services to Medicaid beneficiaries.
    The OIG would also appreciate specific comments related to 
compliance regarding the proposed Medicare ambulance fee schedule.\5\ 
As appropriate, we ask that commenters please provide detailed 
justifications and empirical data supporting such comments.
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    \5\ The Health Care Financing Administration's proposed Medicare 
ambulance fee schedule is expected to be published in the Federal 
Register shortly.

    Dated: August 11, 2000.
Michael F. Mangano,
Principal Deputy Inspector General.
[FR Doc. 00-20856 Filed 8-16-00; 8:45 am]
BILLING CODE 4152-01-P