Patients and ambulance operators in South Carolina are echoing concerns made in other states that a prior authorization program aimed at preventing fraud is doing more harm than good.
Launched by the Centers for Medicare & Medicaid Services in at the end of 2014, the program aims to reduce fraud, waste and abuse by requiring preauthorization for non-emergency ambulance services after reports from the Office of Inspector General showed ambulance transportation claims rose dramatically in certain parts of the country over the last decade. Some estimate that ambulance fraud costs the government as much as $350 million each year.
South Carolina saw the greatest increase in dialysis-related transports, which jumped from 2 percent in 2002 to 48 percent in 2011. But News2 reports that the federal program is inhibiting patient care and putting ambulance companies out of business. Palmetto GBA, the Medicare processing company that oversees ambulance claims, did not reveal how much the program has saved, but told News2 that "prior authorization did not create new clinical documentation requirements," and that the company "maintains an open door policy" to help providers navigate the process.
Ambulance operators in New Jersey have also expressed concern over how the rules impact patient care, and some say the program has forced 11 ambulance companies in the state out of business. However, the preauthorization program is slated to expand to six additional areas--Delaware, the District of Columbia, Maryland, North Carolina, Virginia and West Virginia--starting Jan. 1.
To learn more:
- here's the News2 story
Fraud crackdown drives 11 New Jersey ambulance operators out of business
Ambulance services contribute to $350 million in fraud annually
CMS launches ambulance precertification program
Preauthorization programs have ill effects on patients and ambulance provider