Many hospitals and providers have decided to offer transportation services to patients seeking non-emergency transport to receive various care services. Largely, this strategy makes sense: Each year, millions of Americans miss medical appointments due to transportation issues, representing a lost revenue opportunity for providers and potential health risks for customers.
But hospitals must make sure that payments made for rides do not influence the selection of a provider or supplier of medical services, which is against the law.
Typically, hospitals and health systems partner with companies such as Uber and Lyft, which have entered into the healthcare ridesharing space. But because of complex regulatory and financial issues, these partnerships can occasionally open the door to fraud and abuse. That can leave either the ridesharing company or the provider itself to assume liability for any legal issues.
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"Given the population health strategy in the country right now, non-emergency transportation makes sense, and ridesharing makes sense, because it allows patients to not miss appointments and avoids them having to delay their care," said Elizabeth Scarola, a healthcare practice member at legal consulting firm Carlton Fields. "Over 3 million Americans miss medical appointments every year due to transportation problems. Ridesharing is a $3 billion industry."
Under such arrangements, however, Scarola said it's crucial that providers monitor civil monetary penalties law and anti-kickback statute to ensure these partnerships are on the level. Any payment that's likely to influence the selection of a provider or supplier of medical services may be liable for civil penalties -- up to $10,000 per violation, Scarola said.
And under anti-kickback statute, it's illegal to solicit, pay or receive anything of value in order to get a referral. Violations are punishable by civil or criminal fines ranging from $25,000 to $210,000 per episode, and can even yield five years of prison time in certain instances.
Scarola estimates ridesharing started to take off around 2016. Prior to then, a number of doctors and hospitals started asking the government if they could provide taxis or metro cards to patients to entice them to seek care, particularly in rural areas, where access if often scarce.
In 2016, the Office of the Inspector General, part of the U.S. Department of Health and Human Services, identified various "safe harbors" relating to ridesharing -- various payment and business practices that, although they potentially implicate the federal anti-kickback statute, are not treated as offenses under the statute.
Under these guidelines, transportation services should only be provided to established patients. They should not be targeted toward potentially profitable patient populations, and they must be offered uniformly. These services should not be marketed or advertised, and companies are barred from offering luxury options.
Most ridesharing companies abide by these rules, but there have been instances of, for example, billing for trips that never occurred. According to Scarola, one company in Massachusetts billed for rides to patients who had died. Some of these cases have been settled out of court for as much as $300,000.
While ridesharing companies can be on the hook for these damages, hospitals and providers can be found financially liable as well, depending on the facts and circumstances surrounding an incident. Scarola's advice is to be aware of the fraud and abuse risks. Make sure that both parties, the ridesharing company and the provider, are complying with the safe harbor rules outlined by the OIG.
Besides fraud and abuse issues, prudence is advisable in case other factors come into play, such as a breach of privacy information, which can invoke HIPAA concerns.
Scarola sees the need for caution increasing as ridesharing options become more popular for consumers, and more profitable for providers.
"I absolutely think ridesharing is going to become more prevalent in the healthcare landscape," she said. "As we see the prevalence increasing, like any other new technology, we will see an uptick in the number of regulations to make sure patients are provided with safe services."