MARKETING TO CONSUMERS AND PATIENT REFERRAL SOURCES SCOPE All AMR HoldCo, Inc. and its subsidiaries (the Company ) colleagues. For purposes of this policy, all references to colleague or colleagues include temporary, part-time and full-time employees, independent contractors, clinicians, officers and directors. PURPOSE To assist colleagues of AMR in complying fully with all of the complex laws and regulations governing sales and marketing practices in the health care industry. This governs interactions with all consumers, existing AMR sources of patient referrals as well as those sources of referrals with whom AMR is not currently doing business, but who may become AMR sources of referrals. As this cannot address all situations that may arise, this also is intended to educate colleagues so they can recognize practices that are permissible, practices that are prohibited and practices for which colleagues should seek additional guidance from their supervisor and/or AMR s Legal Department before proceeding. BRIEF OVERVIEW OF THE HEALTH CARE LAWS THAT REGULATE AMR's MARKETING ACTIVITIES WITH SOURCES OF PATIENT REFERRALS It is against the law for anyone to offer anything of value to a consumer, referral source, or potential referral source, in order to influence that consumer, referral source or potential referral source to select AMR's products or services for their patients. For more information, see AMR Compliance on Health Care Laws, No. 10800. GENERAL MARKETING POLICY FOR CONSUMERS AND POTENTIAL PATIENT REFERRAL SOURCES From time to time, AMR may market its services directly to consumers and potential sources of patient referrals, and may desire to offer certain free items and services to consumers, potential referral sources or the general community in order to enhance AMR's name recognition, visibility and goodwill in the community. Under no circumstances will colleagues of AMR, or anyone acting on behalf of AMR, offer any Page 1 of 8
free item or service (or any item or service for less than a fair market value payment) outside the items authorized in this to consumers, referral sources with whom AMR is currently doing business or those referral sources with whom AMR is not currently doing business, but who are in a position to do business with AMR (i.e., become a referral source of AMR). Marketing Personnel should not market AMR's services as being "medically necessary" because the determination of medical necessity requires a case-by-case review of the particular facts and circumstances. Rather, it is important for Marketing Personnel to explain accurately what AMR services may be covered depending upon key facts and circumstances. All Marketing Personnel shall receive training regarding "medical necessity as part of their standard initial compliance training. This training shall be similar to the "medical necessity" training that Intake Personnel and Medical Transport Personnel will receive. See AMR Compliance Policies on Intake Personnel, No. 40100, Medical Transport Personnel, No. 40200 and Medical Necessity, No. 50400. To prevent requests for services that are not medically necessary, Marketing Personnel, in conjunction with Billing Personnel, shall develop a medical necessity training program for customers. This training should be available to all customers, and required for those requesting an excessive number of non-covered transports. In addition to the training, customers shall be provided with written material regarding medical necessity and covered transports for distribution to appropriate facility personnel. Marketing personnel shall only use marketing and training materials which have been approved by the AMR Legal department. GIFTS AND HOSPITALITY FOR CUSTOMERS AND REFERRAL SOURCES AMR occasionally may provide modest gifts to customers and parties who may be in a position to make referrals, but only if the gifts benefit patients or serve a genuine educational function. Other than a gift of medical textbooks or anatomical models used for educational purposes, any gift from AMR should have a fair market value of less than $100 (irrespective of AMR's cost). The aggregate value of all such items given to any individual in any consecutive twelve month period must be less than $300. The purpose of the gift may not be to reward or induce referrals. In addition, AMR may occasionally give customers and referral sources branded promotional items of minimal value related to a health care professional s work or for benefit of patients. Gifts may not be given in form of cash or cash equivalents such as gift cards. Page 2 of 8
It is appropriate for AMR to meet with potential customers and referral sources to discuss its services, contract negotiations, and sales terms. It is appropriate for AMR to pay for occasional hospitality only in the form of modest meals, receptions and other events for such personnel in settings that are conducive to the exchange of information. Hospitality extended in such situations should comply with the guidelines in A above (i.e., no more than $100 per event per person and $300 during any consecutive twelve month period.) It is also appropriate to pay for reasonable travel costs of attendees when necessary (e.g., for site tours or demonstrations of nonportable equipment). However, it is not appropriate to pay for meals, hospitality, travel, or lodging of guests of such persons or any other person who does not have a bona fide professional interest in the information being shared at the meeting. If colleagues of AMR, or anyone acting on behalf of the colleagues, would like to offer a nominal item or service not specifically authorized, or which exceeds the amount specified in this policy, the colleagues must seek review and prior approval from the Legal department and/or Ethics & Compliance department. AUTHORIZED INCENTIVES FOR INDIVIDUALS TO RECEIVE PREVENTIVE HEALTH CARE Incentives given to individuals to promote the delivery of preventative care are specifically recognized as exceptions to these health care fraud and abuse laws. Preventive care is defined in 42 CFR 1003.101 to mean items and services that; are covered by Medicare or Medicaid; and are either pre-natal or post-natal well-baby services or are services described in the Guide to Clinical Preventive Services published by the U.S. Preventive Services Task Force (available online at http://odphp.osphs.dhhs.gov/pubs/guidecps). Such incentives may not be in the form of cash or cash equivalents and may not be disproportionate to the value of the preventive care provided. AMR must receive fair market value compensation for the preventative services themselves (as distinct from the incentives to obtain such services). In accordance with this exception, AMR has authorized that colleagues of AMR, or anyone acting on behalf of AMR, to offer the following incentives to receive preventative care (as defined above) without charge or at a reduced charge to AMR's patients or potential patients in a reasonable and necessary quantity solely for the patient's use: health care pamphlets and similar informational items or training tapes are permissible if they are of nominal value and serve a genuine educational function; Page 3 of 8
transportation to and from preventative care services where such preventative services are offered on a compensated basis by AMR at fair market value; and any of the items specified in Part VI below or other items specifically approved in writing by the Legal department and/or Ethics & Compliance department. OTHER AUTHORIZED ITEMS FOR INDIVIDUALS The OIG has interpreted the prohibition on remuneration to beneficiaries to permit providers to offer beneficiaries inexpensive gifts (other than cash or cash equivalents) or services without violating the statute. For enforcement purposes, inexpensive gifts or services are those that have a retail value of no more than $15 individually, and no more than $75 in the aggregate annually per patient. The following are the only non-health related items that colleagues of AMR, or anyone acting on behalf of AMR, may offer, without charge, to AMR patients or potential patients, so long as they meet the forgoing definition of inexpensive : CPR training offered to the public (or a segment thereof) at large; participation in health fairs; tee shirts, exercise videos, and water bottles provided for participating in a post-cardiac care fitness program; written materials (books, pamphlets, etc.) emphasizing relevant public safety matters; small items with AMR's logo, such as coffee mugs, pens, notepads, key chains, calendars and kitchen magnets; greeting cards; refreshments; and other items specifically approved in writing by the Legal department and/or Ethics & Compliance department. UNAUTHORIZED ITEMS Page 4 of 8
Under no circumstances should colleagues of AMR, or anyone acting on behalf of AMR, offer any of the following types of free items or services to AMR's consumers, referral sources or potential referral sources (or their respective patients), regardless of the retail value of the item or service: cash or cash equivalents such as gift cards or gift certificates; payment of patient s insurance premiums; payment of patient s living expenses; waivers of coinsurance and deductibles unless based on financial hardship authorized by other relevant AMR policies; free AMR services (e.g., paramedics performing services in a hospital ER other than caring for an AMR patient); courtesy transports; any free use of AMR vehicles by referral sources; computers, computer software or fax machines (unless solely for use related to AMR product ordering or the cost-effective medically appropriate usage of AMR's products as approved by a Ethics & Compliance Officer); TVs, VCRs and other entertainment-related equipment; gifts or other items to any individual exceeding a retail (or fair market) value of $100 per item or $407 in any consecutive twelve month period; lodging or travel expenses, except as provided in Section III.B above or with the express prior written approval of the Ethics & Compliance Department; and other items not within the parameters in Section III above, unless approved by the Legal department and/or Ethics & Compliance department. If colleagues believe that an item or service is distinguishable from items listed above, the colleagues must seek review and obtain prior approval from the Chief Compliance Officer, who may consult legal counsel in making the final determination. Page 5 of 8
TRANSPORT COORDINATOR "Transport Coordinators" are personnel trained by the Billing Department to facilitate the costeffective and efficient performance of services by AMR in health facilities with a high volume of transports. These transport coordinators represent a contractual relationship with a referral source which is governed by AMR Compliance on Contractual and Other Financial Relationships/Arrangements with Health Facilities, No. 30200 (See Attachment A). Pursuant to this policy, a health facility may not receive any service intended even in part to induce the referral of business to AMR. However, AMR may utilize its own personnel (such as a Transport Coordinator) to perform bona fide services for AMR which are necessary for the proper performance of its business. All contracts or arrangements which involve the placement of transport coordinators in a health facility without fair market value compensation to AMR must be reviewed by the AMR Legal department. ATTACHMENTS: Attachment A: Transportation Coordinator Job Description (see next page). Page 6 of 8
TRANSPORTATION COORDINATOR JOB DESCRIPTION The central responsibility of a Transportation Coordinator is to schedule patient transports as requested by the hospital staff, including staff from Case Management, Social Services, Emergency Room and any other appropriate hospital department. Unless the hospital compensates AMR for additional services, the function of the Transportation Coordinator is solely to facilitate the efficient and economical performance by AMR of its contractual obligations to a hospital. In order to successfully complete his or her responsibilities and duties, a Transportation Coordinator shall: Coordinate with hospital staff in order to project the following weeks discharge requirements. The Transportation Coordinator shall anticipate equipment requirements in relation to the discharge protocol. Coordinate hospital discharges to maximize AMR s fleet efficiency. The Transportation Coordinator shall verify the mode and level of transportation for each trip scheduled. Coordinate transportation times with the receiving facilities, including extended care facilities, rehabilitation centers, skilled nursing facilities and any other outside facilities. Reconfirm the scheduled discharge and transport with the appropriate hospital staff. Utilize hospital s patient information to complete all relevant AMR transportation documents. Track and log all incidents when a patient s discharge times cannot be met by AMR and the reasons. Verify, in instances of critical care transports, that the necessary equipment and personnel are available and utilized. The following tasks are not part of a Transportation Coordinator s responsibilities and should never be performed by a Transportation Coordinator without first receiving approval from Regional Management. Making initial contact with patients only make contact with patients after the hospital discharge planner refers you to that patient. Providing or performing any hospital services (such as filing and answering phone calls) even if the hospital is short-staffed or as a favor to a friend. Page 7 of 8
Sharing proprietary information with the hospital. Giving gratuities or gifts to hospital colleagues. Pressuring hospital colleagues to send you more referrals or providing any gratuities in exchange for providing referrals. On-site marketing. Page 8 of 8