The guidelines highlight key areas to enhance overall preparation and response to potential or diagnosed Ebola patients

The Centers for Disease Control and Prevention recently released a checklist aimed at preparing EMS agencies to recognize and treat patients with Ebola.

Highlights include:

• Train all EMS personnel on how to identify signs and symptoms of Ebola infections and to avoid risk of exposure
• Consider travelers with fever, fatigue, vomiting and/or diarrhea and returning from affected West African countries as potential cases, and obtain additional history.
• Post screening criteria in conspicuous locations in EMS units, at EMS stations, and in other locations frequented by EMS personnel (see suggested screening criteria).
• Designate points of contact within their EMS organization/system responsible for communicating with state and local public health officials. Remember: Ebola must be reported to local, state, and federal public health authorities.
• Conduct a detailed inventory of available supplies of PPE suitable for standard, contact, and droplet precautions. Ensure an adequate supply, for EMS personnel, of:
• • Fluid resistant or impermeable gowns
  • Gloves
  • Shoe covers, boots, and booties
• Maintain an appropriate combination of the following:
• • Eye protection (face shield or goggles)
  • Facemasks (goggles or face shield must be worn with facemasks)
  • N95 respirators (for use during aerosol-generating procedures)
  • Other infection control supplies (e.g. hand hygiene supplies).
• Ensure procedures are in place to require that all EMS personnel accompanying a patient in a transport unit are wearing (at minimum): gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and a facemask
• Review, develop, and implement plans for: adequate respiratory support, safe administration of medication, and sharps procedures; and reinforce proper biohazard containment and disposal precautions
• Plan for regular situational briefs for decision-makers, including:
• • PUI for Ebola who have been identified and reported to public health authorities
  • Isolation, quarantine and exposure reports
  • Supplies and logistical challenges
  • Personnel status
  • Policy decisions on contingency plans and staffing​​

​​Read the full checklist

The Federal Office of Rural Health Policy (ORHP) is pleased to announce that the FY15 Rural Health Care Services Outreach Grant Program funding opportunity announcement (announcement number: HRSA-15-039) is now available. To access the application package and learn more about the funding opportunity announcement, please click on: http://www.grants.gov/view-opportunity.html?oppId=264030 (look under ‘application package’ tab)

 

 

BRIEF SUMMARY (Refer to HRSA-15-039 funding opportunity announcement for more details and information)

A.     Eligibility criteria

The lead applicant must be a rural non-profit or rural public entity that represents a consortium of at least 3 health care providers.

 

B.     Purpose and Goals of FY15 Outreach grant program:

The purpose of this grant is to improve outreach and service delivery in local and regional rural communities.  The goals for the Outreach Program are the following:

o   Expand the delivery of health care services to include new and enhanced services exclusively in rural communities

o   Deliver health care services through a strong consortium, in which every consortium member organization is actively involved and engaged in the planning and delivery of services

o   Utilize and/or adapt an evidence-based or promising practice model(s) in the delivery of health care services

o   Improve population health, demonstrate health outcomes and sustainability

 

C.     Award amount:

o   Applicants can request up to $200,000/year for three years.

 

D.     Deadline to apply:

o   The deadline to submit an application in www.grants.gov is November 14, 2014.  ORHP strongly recommends that applicants submit their applications prior to the due date to avoid any technological problems. All applications have to be submitted electronically in www.grants.gov and waiver requests to submit a paper copy application will not be accepted.

 

E.      Technical assistance webinar:

There will be a technical assistance webinar on Wednesday, September 24, 2014 from 1:00-2:30pm EDT to assist applicants in preparing their applications. The technical assistance webinar is open to the general public.  The purpose of the webinar is to go over the funding opportunity announcement, and to provide any additional or clarifying information that may be necessary regarding the application process.  There will be a Q&A session at the end of the webinar to answer any questions.  While the webinar is not required, it is highly recommended that anyone who is interested in applying for the FY15 Outreach Program plan to listen to the webinar.  It is most useful to the applicants when the funding opportunity announcement is easily accessible during the call and if questions are written down ahead of time for easy reference.

 

Call-in number (for audio): 888-282-9630 // passcode: 1632772

URL (for web): https://hrsa.connectsolutions.com/fy15_outreach_foata/

 

Prior to joining, please test your web connection: https://hrsa.connectsolutions.com/common/help/en/support/meeting_test.htm.

 

Note: You must dial into the conference line to hear the audio portion of the webinar. No registration is required.  To access the webinar recording, visit http://www.hrsa.gov/ruralhealth/about/community/careservicesoutreach.html.

 

FY15 Rural Health Care Services Outreach FOA program contact:

Linda Kwon, MPH

Rural Health Care Services Outreach Program Coordinator

Office of Rural Health Policy

Telephone:  (301) 594-4205

The Wisconsin STEMI coordinators group met on October 3 in Janesville.  The group met to discuss statewide STEMI efforts, statewide benchmarks and recent convers ations at the State Capitol.  In addition, the group sought input from EMS representatives.

PAAW President Patrick Ryan was invited to speak at the meeting.  He offered this comment afterwards, "We appreciate the STEMI coordinators' invitation.  It is great to see them include EMS in their statewide planning, since ambulance services are an important and essential part to developing any successful statewide program."

The Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2014 (H.R. 5460) was recently introduced in the U.S. House of Representatives.  The bill would make several key reforms to the Medicare ambulance fee schedule including as of April 1, 2015 the permanent extension of the current temporary Medicare 2% urban, 3% rural and super rural add-on payments. 

“In developing H.R. 5460, Congressmen Greg Walden (R-OR), Peter Welch (D-VT), Devin Nunes (R-CA) and Richard Neal (D-MA) developed a sensible and bipartisan approach to addressing below cost Medicare reimbursement of ambulance service providers and implementing important reforms,” said Jimmy Johnson, AAA President.  “This is the most significant legislation on Medicare reimbursement and policy since the Balanced Budget Act of 1997 and the creation of the Medicare ambulance fee schedule.”

In addition to making the current relief permanent, H.R. 5460 would: 

1. Implement prior authorization for Basic Life Support (BLS) non-emergency ambulance transports to and from dialysis centers,
2. Change the status of ambulance service suppliers to provider.
3. Direct the Centers for Medicare and Medicaid Services (CMS) to collect ambulance cost data using a survey methodology.

“Ambulance service providers and our paramedics and EMTs are often the health care professionals to first come into contact with a patient and we are providing state-of-the-art medical care to ensure better patient outcome,” said Johnson.  “H.R. 5460 will not only address several of the current issues facing our profession but also put us on a path for Congress to make data-driven decisions on the future role ambulance service providers will play in our changing health care system.”

Source: American Ambulance Association

Two former Sullivan Emergency Medical Service members charged with theft and misconduct in public office were released on $10,000 signature bonds on Tuesday, September 16.

Kimberly Heine and Richard Heine, of Helenville, the former deputy chief and chief of Sullivan EMS, respectively, are accused of fraudulent actions relating to funds and property associated with the former emergency medical service.

The couple appeared before Jefferson County Circuit Court Judge Jennifer Weston to face the charges, including one count each of theft-false representation over $10,000 and misconduct in office-fraudulent records/statement. In addition, Kimberly Heine is charged with one count of identity theft for financial gain.

If convicted, Kimberly Heine faces a combined maximum sentence of 19 1/2 years in prison and fines of more than $45,000, while Richard Heine could be sentenced to a maximum of 13 1/2 years in prison and fines totaling more than $35,000.  A pre-trial conference at the District Attorney’s Office was scheduled for Wednesday, Oct. 15.

The Heines are not to work for any ambulance or EMS service, but were granted permission to continue operating their medical transportation business called Sullivan Prestige Ambulance Inc. or Prestige Transports, as long as they only are paid directly by the users of that service and not handling the clients’ accounts. As ordered, they are not to engage in any business in which they are entrusted with someone else’s money.

According to the criminal complaint, the theft and misconduct in office offenses allegedly committed by the pair occurred between January 2011 and June 30, 2012. The single count of identity theft for financial gain charged against Kimberly Heine relates to her alleged use of the Sullivan EMS phone number from July 3, 2012, to August 20, 2012.

The Jefferson County Sheriff’s Office was contacted by the Sullivan EMS Secretary/Treasurer Nancy Emons about the service’s telephone number being disconnected and ported to a personal U.S. Cellular account in the name of Kimberly Heine in August 2012.

The couple had been suspended from their duties within Sullivan EMS on June 23, 2012, pending the outcome of an internal investigation and audit. The suspension had been the result of allegations that the pair had mismanaged funds and assets at Sullivan EMS as chief (Richard) and deputy chief (Kimberly) and administrative assistant.

Kimberly Heine did all the recordkeeping as part of her duties as administrative assistant, including payroll.

The Sullivan EMS Board of Directors voted to terminate the couple’s employment on July 3, 2012, and on July 9, Emons reportedly contacted the telephone company asking it to remove the pair as authorized persons on the account, the complaint said.

The board believed Heine was attempting to start her own emergency transport company using the Sullivan EMS telephone number.

Kimberly Heine admitted to authorities of taking possession of the phone number “due to the fact that Sullivan EMS had abandoned the number.”

According to the complaint, she said members of Sullivan EMS had asked her to find a way to cut the phone bill and that they were aware that the phone number in question would be cancelled to reduce the bill.

Emons reportedly countered that a conversation about reducing the phone bill was held; however, “cancelling the main phone line was never an option.”

Kimberly also allegedly admitted in an interview with detectives that her new transport company, Sullivan Prestige Ambulance, was providing inter-facility transportation, which Sullivan EMS no longer provided, and that people contacting her at the stolen Sullivan EMS number for this service could get it through her company, the complaint said.

Under Federal Communications Commission requirements, a tax identification number was required for control of the phone number.

Kimberly stated that a U.S. Cellular employee provided the tax identification number, but she admitted that she and her husband had access to the Sullivan EMS tax identification number because it was stored in their home, according to the complaint.

The mentioned U.S. Cellular employee denied providing the tax identification number, stating in the complaint that he only had access to the last four digits of the number.

Even after the number had been returned to Sullivan EMS, investigators attempted to contact Kimberly using a phone number she provided and in reaching her voicemail found she was still representing herself as being affiliated with Sullivan EMS.

Further investigation related to the Heines’ alleged illegal runs by Sullivan EMS that were not reported to LifeQuest, the processor for Sullivan EMS.

Kami Warren, former Sullivan EMS chief, provided documentation which details a total of 533.25 runs Kimberly submitted to Sullivan EMS payroll, but not to LifeQuest. By statute, all runs by Sullivan EMS had to be reported to LifeQuest.

According to the complaint, Warren’s documentation also showed 499 runs reported by Richard Heine to Sullivan EMS, but not to LifeQuest.

Reports show that Sullivan EMS overpaid Kimberly Heine $13,647.50 for runs and Richard by $13,514.75.

It was further noted that “at no time was Kimberly approved to receive $1,250 per month as a regular monthly stipend.”

Kimberly was appointed as both deputy chief of inter-facility and administrative assistant beginning Sept. 1, 2011, with a total monthly stipend of $700.

Payroll summaries in the complaint show that Kimberly received a stipend in excess of $17,503 from January 2011 to June 2012.

When confronted with the allegations, the Heines defended the unaccounted-for runs, citing that LifeQuest would deny runs because they were not medically necessary or that runs were not billed because they were submitted through the Sentimental Journeys program.

The couple also said runs would go unreported if they lasted more than two hours, the complaint said.

Source:  Ryan Whisner, Daily Union regional editor

On September 17, Jack Hill, executive director at Gold Cross Ambulance Service, headquartered in Menasha, was named 2014 Wisconsin Honorary Star of Life and Lifetime Member of the Professional Ambulance Association of Wisconsin. 

 

The award was presented by the Professional Ambulance Association of Wisconsin where Hill is treasurer and serves on the board of directors.  Governor Scott Walker acknowledged the moment by providing Hill with a certificate of appreciation for his many years of service to citizens of Wisconsin.  The award presentation and recognition dinner was held at Tundra Lodge in Green Bay during the annual Paramedic Systems of Wisconsin Conference.  Several Gold Cross Ambulance employees, pictured with Hill, attended the program to celebrate the occasion.

 

During his 21 years of leadership, Gold Cross has grown from 60 employees to more than 160, and from 8 ambulances to 17. The company has incorporated new technologies and clinical care protocols while he’s been at the helm, and has expanded to become a regional service covering 1,200 square miles of Outagamie, Winnebago, Calumet and Waupaca counties, serving more than 260,000 people.

 

As a part-time police officer in mid-1976 in his home town of Hoyt Lakes, MN, Hill got a taste of the career that would eventually become his passion.  He was hired at Gold Cross in 1985 as a paramedic, when he decided to turn his volunteer EMS work into a career. Today, looking back over 29 years with Gold Cross, he remains committed to the quality, efficiency, dedication, compassion and professionalism that characterize the company and his life.

 

In early 2015, Jack and Noi Hill will live part-time in Thailand, spending time with family, enjoying a life of retirement and new adventures.

(Picture insert, left to right, Professional Ambulance Association of Wisconsin President Patrick Ryan, Jack Hill, Noi Hill)

WASHINGTONundefinedThe general manager of a Southern California ambulance company pleaded guilty yesterday in Los Angeles to conspiracy to commit Medicare fraud, conspiracy to obstruct a Medicare audit, and making materially false statements to law enforcement officers.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney Stephanie Yonekura of the Central District of California, Special Agent in Charge Glenn R. Ferry of the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and Assistant Director in Charge Bill Lewis of the FBI’s Los Angeles Field Office made the announcement.

Wesley Harlan Kingsbury, 34, of Bloomington, California, pleaded guilty to the charges before U.S. District Judge Dale S. Fischer. Sentencing is scheduled for Feb. 9, 2015.

According to court documents, Kingsbury was the general manager of Alpha Ambulance Inc., which specialized in the provision of non-emergency ambulance transportation services to Medicare beneficiaries, primarily to and from dialysis treatments. Between April 2010 and July 2012, Kingsbury conspired with Alex Kapri and Aleksey (Russ) Muratov, the owners of Alpha Ambulance, as well as the training supervisor Danielle Medina, to bill Medicare for ambulance transportation services for individuals that Kingsbury knew did not need to be transported by ambulance. In addition, as general manager, Kingsbury instructed emergency medical technicians (EMTs) that worked at Alpha Ambulance to conceal the true medical condition of patients they were transporting by altering requisite paperwork and creating false reasons to justify the transportation services.

In early 2012, Medicare notified Alpha Ambulance that the company would be subject to a Medicare audit. In response, Kingsbury and his co-conspirators altered patient documentation to create false justifications for the ambulance transportation services. Kingsbury and others used light tracing tables to trace over original documents and create falsified patient documentation for the purpose of sending those falsified documents to Medicare, and then they used a paper shredder to destroy the original patient documents.

Kingsbury and his co-conspirators submitted $5,522,079 in fraudulent claims to Medicare, and Medicare paid $1,338,413 on those fraudulent claims.

Further according to court documents, in April 2012, Kingsbury was approached by law enforcement officers and was asked to assist with the investigation into Alpha Ambulance. Kingsbury disclosed to the owners of Alpha Ambulance the names of the law enforcement officers who were conducting the investigation and the questions they had asked Kingsbury about the company. On May 1, 2012, Kingsbury falsely denied to the law enforcement agents that he had previously disclosed that information to the owners of Alpha.

Kapri, Muratov and Medina pleaded guilty to conspiracy to commit health care fraud on October 28, 2013. They were sentenced to terms of imprisonment of 75 months, 108 months, and 30 months, respectively.

The case was investigated by the FBI and the Los Angeles Region of HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. The case was prosecuted by Trial Attorneys Blanca Quintero and Alexander F. Porter and Assistant Chief Ben Curtis of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Medicare reimbursement rates will increase by 1.4% for ambulance services in 2015, but that's not the whole story.  CMS is also proposing to change designations of certain zip codes from rural to urban and vice-versa in 2015, and this would affect reimbursement amounts to ambulance providers picking up in those zip codes.  Moreover, unless Congress passes legislation, the urban, rural and super-rural ambulance bonus payments will expire on March 31, 2015. There are a lot of big things set to impact ambulance reimbursement in the coming year.

Source:  Page, Wolfberg and Wirth EMS Attorneys

By David M. Werfel, Attorney, American Ambulance Association

When the patient is unable to sign the form requesting payment and authorizing the release of records due to a physical or mental condition, the request may be executed on their behalf by a legal guardian, relative, representative payee or representative of an institution providing care.
 
Until now, the person signing on behalf of the patient was required to also list their name, address, relationship to the patient and reason the patient could not sign.

Over two years ago, I asked CMS to remove the requirement of the address, when one of the Medicare Administrative Contractors (WPS) notified ambulance suppliers the address was required.  The requirement of the address of the person signing on behalf of the patient was impractical as there was no space on the 1500 form for it, no field for it on electronic claims, it was not required in the CMS Regulation (42 C.F.R. 424.36) and the industry would usually not be able to obtain it.

After many follow-ups, CMS has removed the requirement in Transmittal 2984.

Link to transmittal: 
https://www.cms.gov/ Regulations-and-Guidance/ Guidance/Transmittals/ Downloads/R2984CP.pdf

In sum, the address of the person signing on behalf of the patient is no longer needed.

The Professional Ambulance Association of Wisconsin Board of Directors is pleased to announce they have recently appointed attorney Thomas Shorter as their consultant on health care matters, to include the Affordable Care Act.  Mr. Shorter is with the firm Godfrey & Kahn in Madison. 

 

According to PAAW President Patrick Ryan, “Mr. Shorter is highly regarded for his health care knowledge and awareness to ACA.  We look forward to his expertise as we anticipate many questions about ACA and navigating it both as healthcare providers and as EMS employers.  Having this relationship in place will help the Association, its members and other ambulance services that need a resource to consult.”

 

Mr. Shorter added, “We greatly value our new relationship with PAAW.  Under the Affordable Care Act (ACA) the United States is rapidly moving towards more alignment of all health care providers, both clinically and economically.  Ambulance service providers are a critical element of the system, and often the entry-point into the system.  Our expertise in health care and corporate law allows us to partner with PAAW and its members to address the legal issues in the evolving healthcare landscape.  We look forward to a long and relationship with PAAW.”

 

Mr. Shorter was also recently appointed to the Board of Directors for the American Health Lawyers Association, which is the largest national health law association in the US.