EMS Legal

  You are the division chief responsible for emergency medical services (EMS) provided by a suburban fire department. The fire department you represent provides 911 EMS at the advanced life support level for both first response and transport services. Likewise, the organization has a policy in place that indicates all citizens calling 911 and requesting transport from a location within the city to an approved receiving hospital identified by city ordinance will be provided with fire department transport services in an ambulance. Finally, private ambulance companies and a health-care-system-based ambulance service provide nonemergency interfacility medical service transports within the city. Recently, it has come to light that a fire department of similar size and with the same EMS mission has been the focus of a federal investigation for business practices allegedly in violation of the False Claims Act (FCA). More specifically, the investigation is focused on the transport of patients who did not meet the two criteria established by federal law as “medically necessary” and the subsequent reimbursement requests submitted to and approved by Medicare (Part B). The investigation was triggered by a whistleblower lawsuit initiated by an employee of the fire department. Additionally, the organization is believed to be at risk for a civil lawsuit based on the whistleblower protection provided under the FCA, as the whistleblower was terminated by the organization for initiating the lawsuit. The fire chief asks you to conduct an analysis of this scenario, a correlated evaluation of current, relative fire department business practices to determine if patients being transported meet both criteria for being “medically necessary.” The fire chief asks that the memo include the findings of your analysis and evaluation along with suggested best practices for avoiding violations of the FCA (relative to submitting reimbursement requests for transported patients). Finally, the fire chief asks that the memo address retaliation protection provided to whistleblowers under the FCA. Your memo should address at least the items listed below. Include the applicability of the FCA to patient transport and business practices for federal reimbursement requests. Describe best practices for determining compliance with the “medically necessary” patient transport criteria required for Medicare (Part B) reimbursement. Provide a brief review of other applicable laws and best practices for avoiding violations. Describe the whistleblower protection provided under the FCA. Describe the penalties for violations of the identified federal laws. Provide recommendations for revising department policy and business practices to avoid violations of the FCA. Your memo should be at least three pages in length. Select three scholarly sources to support your memo, one of which should be the course eTextbook