Medicare Paid $54 Million for Medically Unnecessary and “Mystery” Ambulance Rides

The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently released a detailed study of ambulance transports billed to Medicare Part B in the first half of 2012 that identified millions of dollars of dubious and potentially fraudulent payments. Of the $2.86 billion paid by Medicare for ambulance services in those six months, the September report stated that $207.5 million went toward transports associated with questionable billing practices.

At least $30 million of the improper payments were for ambulance rides where the OIG could find no record of the patient ever receiving any kind of medical care – the so-called “mystery rides.” Another $24 million was paid for transports to destinations not covered by Medicare. The study also determined that more than 1 in 5 ambulance suppliers implemented questionable billing practices. A copy of the full OIG report can be found here.

Medicare only covers ambulance transports when a patient’s medical condition at the time of transport is such that other means of transportation would endanger the patient’s health. Additionally, the transport must be to receive or return from a medically necessary Medicare service. If an ambulance transport fails to meet these criteria, it is not billable to Medicare. Knowingly billing the federal government for fraudulent medical services constitutes a violation of the False Claims Act.

Among the most common kinds of ambulance fraud and false Medicare claims are the following:

• Billing for medically unnecessary dialysis transportation;
• Billing for transportation to routine medical appointments, such as radiology or radiation treatment;
• Billing for a higher level of service than was actually provided, such as coding a basic life support transport as one for advanced life support, which is reimbursed at a much higher rate;
• Charging for supplies or services that were not actually rendered, such as oxygen and cardiac monitoring; and
• Entering into agreements with facilities like hospitals and nursing homes where the ambulance company provides reduced-cost transports in exchange for transport referrals, in violation of the Anti-Kickback Statute.

If you have knowledge of any of the above schemes or other fraud in connection with ambulance transports, contact our attorneys for a free consultation at (877) 915-4040.