November 1, 2011



May I legally provide my patients transportation to appointments?


Dr. D


Like so many of our answers on this forum – it depends. Certainly under the anti-kickback statute in certain situations free transportation would be viewed as “illegal remuneration” encouraging and enticing patients (improperly) to select you as their provider. However, under certain other circumstances the government has acknowledged free transportation to “have important and beneficial effects on patient care.” See OIG Advisory Opinion No.09-01.

So, how do we know if your providing transportation will result in potential liability for your practice? Well, the Office of the Inspector General has set forth a list of factors to help determine whether the provision of transportation is improper, as follows:

(1) Is the selection criteria for free transportation in any way correlative to the volume or value, whether anticipated or actual, of federally reimbursable procedures? If eligibility is determined in part by the diagnosis, condition or anticipated treatment required; the remuneration shall be viewed as suspect.

(2)What is the geographical area for transportation? If the free transportation is used to expand the provider’s historical service area, or has patients bypassing other capable practitioners it will likely be viewed as suspect.

(3) Are other means of transportation readily available? Free or subsidized transportation arrangements will be considerably less suspect in areas where there are few readily accessible affordable transportation alternatives.

(4)Does the provider of the transportation bear the cost of transit? It is impermissible for the cost of transportation to be passed on to the Federal government.

(5) Is the provider advertising? When a free transportation arrangement is advertised, especially across a large geographic area, it is more likely to be viewed as suspect.

(6) What are the means of transport? Luxurious or specialized transportation such as airplanes or ambulance transports are more likely to be viewed as suspect.

Each of the above factors illustrates a concept the Office of Inspector General has determined as demonstrative of an improper arrangement, and none of the above factors would be considered independently of the situation as a whole. And, just because the transportation you are providing may fall within a factor set forth above, does not necessarily mean you are exposed to liability. Instead, it is important to understand that standards set forth by the Office of Inspector General are meant to be instructive, and not interpreted as binding rule, and that the factors are not exclusive or exhaustive.

So, what to do if you want to offer transportation? I recommend you have your specific practice arrangement and your proposed business model reviewed. Also be sure you have proper consent forms in place for patient transport.

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