An investigation by the Inspector General’s office detected Medicare payments for potentially fraudulent ambulance rides of $54 million in the first half of 2012. During the year, Medicare Part B paid $5.8 billion for ambulance transportation, double what it paid ten years earlier.
The investigators found approximately $24 million in payments by Medicare were not for rides valid under the program requirements. Additionally, Medicare paid $30 million for transportation where there is no evidence that services were provided for the patient at either the pick-up or drop-off location. If the amounts are extrapolated out to a full year, that would be more than $100 million lost to Medicare fraud in this area alone.
The problem was not limited to one company or geography. Approximately one in five suppliers had questionable billing and four metropolitan areas accounted for half of the questionable transports. One of the areas was Philadelphia, with Los Angeles, New York and Houston also causing problems.
The report details a number of the various fraudulent schemes uncovered as background. These include unnecessarily transported patients, upcoding claims from basic to advanced life support transportation, and transporting patients to and from home when that level of service is limited to emergencies. Other claims involved the falsification of transport documents, transporting patients together but submitting claims for reimbursement of individual transports, and the illegal payment of kickbacks to patients.
There were also a number of unusual scenarios, such as urban ambulance services requesting reimbursement for rides with an average distance of more than 100 miles per ride when the national average is just 10 miles. Additionally, 46 ambulance companies were paid for transportation where there is no evidence of medical services provided in 9 out of the 10 rides.
The results of the OIG were shared with Medicare last year and they have already started taking action upon them. One way that individuals can assist Medicare is by bringing cases of ambulance fraud to the attention of the Justice Department through a False Claims Act lawsuit. This law provides whistleblowers (known as relators under the law) with rewards of between 15 and 30 percent of money recovered by the federal government due to fraudulent claims for Medicare and Medicaid payments.