• The Office of Inspector General ("OIG") Approves a Cost-Sharing Arrangement
  • January 29, 2009 | Authors: Joseph V. (Joe) Geraci; Mia C. Garcia
  • Law Firms: Brown McCarroll, L.L.P. - Austin Office ; Brown McCarroll, L.L.P. - Houston Office
  • On December 19, 2008, the OIG posted Advisory Opinion 08-23 approving a county’s proposed use of its tax revenue for payment of the county’s emergency medical service’s (“EMS’s”) transportation costs where those costs are otherwise mandatory sharing amounts.

    Under the proposed arrangement, the county would not bill bona fide county residents who receive EMS transportation to hospitals for otherwise applicable cost-sharing amounts (e.g., co-payments and deductibles). The county would accept payment from insurers, including Federal health care programs, as payment in full for the EMS transportation, with tax revenues  covering the cost-sharing amounts.

    The OIG reiterated its concern over potentially abusive waivers of Medicare cost-sharing amounts under the anti-kickback statute. But the OIG referenced its special rule for providers that are owned and operated by a state or a political subdivision of a state, such as a fire department. In particular, the OIG concluded that since in this case, Medicare would not require the county to collect cost-sharing amounts from residents, the OIG  would not impose sanctions.