Medicare Dollars Are Still Siphoned Through Ambulance Fraud

“Ambulance service companies should be focused on the needs of the patients,” said HHS Office of Inspector General Special Agent in Charge Phillip Coyne. He continued:

Billing Medicare for ambulance rides that were unnecessary or at a higher rate than could be medically justified is unacceptable. Together with our law enforcement partners, we will seek out and stop this fraudulent behavior.

In September 2015, the Department of Health and Human Services, Office of Inspector General released a study entitled, “Inappropriate Payments and Questionable Billing for Medicare Part B Ambulance Transports.” Many tens of millions of dollars billed to Medicare were the result of improper payments and questionable billing by ambulance suppliers.

For example, Medicare paid for ambulance transports that did not meet certain requirements to justify payment such as transports that were to or from non-covered destinations such as physicians’ offices.  In other claims examined, beneficiaries did not receive Medicare services at either pick-up or drop-off locations, or anywhere else!  Questionable billing issues tended to be concentrated in metropolitan areas; which included unusually high average mileage for transports provided to beneficiaries in urban areas.  This study not only concluded that Medicare has been quite vulnerable to ambulance transport fraud but that ambulance transports warrants scrutiny given its vulnerability.

Not all ambulance fraud can be found by the Government on its own. Medicare fraud continues to deprive the public fisc and rewards wrongdoers, unless courageous whistleblowers come forward.  The law firm of Nolan Auerbach and White devotes all of its resources to representing healthcare whistleblowers.