Medicare spent more than $30 million during the first half of 2012 on ambulance transports for patients that appear to be ghosts on paper, according to a new report released by the Office of Inspector General (OIG) Tuesday.
The report revealed that ambulance companies were reimbursed for providing transportation to beneficiaries that did not receive Medicare services at any origin or destination, nor did they receive Medicare services within one day of being transported.
Exactly what the Centers for Medicare & Medicaid Services (CMS) paid for remains a mystery, although auditors concluded that these were likely instances in which transports didn't take place at all, or if they did, the services beneficiaries received did not justify the need for emergency transportation.
The $30 million in mysterious payments is perhaps the most egregious finding in a report that highlights ongoing concerns about questionable billing within the ambulance industry. OIG auditors found that one out of every five ambulance providers exhibited questionable billing, and a high percentage of those providers were located in four metropolitan areas: Philadelphia, New York, Los Angeles, and Houston. Approximately $24 million payments did not meet program requirements to justify payment, and an additional $17 million was attributed to transportation to non-covered destinations such as physicians' offices.
As a result, the OIG recommended that CMS consider a temporary moratorium on ambulance supplier enrollment in additional geographic areas. In July, CMS extended its temporary moratoria on new ambulance providers in certain areas of Florida, Illinois, Michigan, Texas, Pennsylvania and New Jersey. CMS has also rolled out precertification programs in New Jersey, South Carolina and Pennsylvania.
Additionally, auditors recommended CMS require ambulance suppliers include the National Provider Identifier of certifying physicians in Medicare claims, increase monitoring of ambulance billing, and review the claims outlined in the OIG report.
Questionable billing and outright fraud has become a pervasive problem within the ambulance transportation industry, contributing an estimated $350 million in Medicare fraud each year. Although some states have enacted preauthorization programs to stem the tide of fraud, patients have complained the programs interfere with access to care. As FierceHealthPayer: Antifraud previously reported, hospitals and ambulance companies will share the burden of fraud liability as feds begin investigating more schemes.
- read the OIG report