- Medicare paid $30 million for transports for which “the beneficiaries did not receive Medicare services at the pick-up or drop-off locations, or anywhere else,” according to an audit published this week by the HHS Office of Inspector General. “These claims may have been inappropriate.”
- HHS OIG performed the audit because, historically, Medicare has been vulnerable to fraud involving ambulance transports and, in 2012, Medicare Part B paid $5.8 billion for such transports, double the amount in 2003.
- The findings “pose vulnerabilities to Medicare program integrity,” according to the report.
The auditor identified both improper payments for ambulance transports and questionable billing by ambulance suppliers. “We found that Medicare paid $24 million in the first half of 2012 for ambulance transports that did not meet certain program requirements to justify payment,” the audit stated. “For example, Medicare paid $17 million for transports that were to or from noncovered destinations such as physicians' offices.”
The audit found for 642 suppliers that had questionable billing for excessive mileage for urban transports, the average distance was at least 34 miles, and for 48 of such suppliers, the average urban transport distance was over 100 miles.
Thus, the agency recommended CMS enhance fraud and abuse safeguards, including:
- Determine whether a temporary moratorium on ambulance supplier enrollment in additional geographic areas is warranted;
- Require ambulance suppliers to include the National Provider Identifier of the certifying physician on transport claims that require certification; and
- Increase ambulance billing monitoring of ambulance billing.