Regent Management Services will pay $3.2 million to settle allegations that it received kickbacks from ambulance companies in the form of low-cost ambulance transports in exchange for referrals of Regent’s Medicare and Medicaid patients to the ambulance companies.

This is believed to be the first time a nursing home operator, as opposed to an ambulance company, has been held accountable for a “swapping” arrangement.  Under such an arrangement, the ambulance company agrees to provide a nursing home or hospital with low-cost ambulance transports when the nursing home or hospital is required to pay for the transports.  In return, the nursing home or hospital agrees to refer other patients to the ambulance company when Medicare or Medicaid will pay for the transports.

Such “swapping” agreements violate the Anti-Kickback Statute.   That law prohibits offering, paying, soliciting, or receiving anything of value in exchange for referrals of items or services covered by Medicare or Medicaid. 

The federal government has made clear that swapping arrangements are an area of concern throughout the ambulance industry, and that it intends to investigate and prosecute these cases aggressively.