Health System's Free Shuttle Rides Wouldn't Yield Sanctions, OIG Says

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By James Swann

Oct. 21 — A rural health system's proposed plan to offer patients free van shuttle rides to certain medical facilities wouldn't result in the imposition of administrative sanctions under the anti-kickback statute, according to an advisory opinion issued Oct. 21.

The Department of Health and Human Services Office of Inspector General's advisory opinion (15-13) said the rural area where the health system operates has limited public transportation, which the health system said could prevent patients from receiving care.

Under the proposed arrangement, the health system would operate two van shuttle routes: one that would run 18 miles and stop at three of the health system's facilities, and another that would run 10 miles and stop at two medical facilities.

Shuttle rides would be available from 8 a.m. to 6 p.m., with the vans making 10 full trips on each route everyday, and the health system would also maintain a “drop-off and pick-up” site.

In addition, transportation would be available to all patients, regardless of their health-insurance status, and shuttle rides wouldn't be based on a patient's past or future use of federal health-care program services within the health system.

No health-care services would be marketed to the patients during the rides, the advisory opinion said, and the transportation service wouldn't be marketed to the general public. Instead, it would only be shared with existing patients of physicians employed by the health system, or in the case of one medical facility, patients of private physicians who practice at the facility.

OIG Legal Analysis

While offering patients access to free transportation could constitute an inducement for the patients to obtain government-covered services from the health system, the OIG outlined several factors that it said mitigate the risk of fraud and abuse, including:


• the shuttle rides wouldn't be predicated on how much federal health-care program volume a patient could generate for the health system, and would be offered regardless of a patient's health-insurance status;
• the shuttle rides wouldn't be luxurious or offer ambulance-style amenities, which could serve as patient inducements;
• the shuttle van drivers wouldn't be paid for each individual patient transported;
• the shuttle rides would only operate on a local basis, and wouldn't recruit additional patients from competing health systems;
• the costs of the shuttle rides would be paid for by the health system and not billed to Medicare or any other payers; and
• patients would not receive any health-care marketing materials during their rides.


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To contact the editor responsible for this story: Brent Bierman at

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