September 30 2015
Patrice J. Lee
Medicare, the whopping multi-billion dollar federal social safety net program that provides healthcare for 50 million elderly and disabled Americans, is plagued with fraud, abuse, and waste. No surprise there, unfortunately.
What is surprising? The creativity of the latest bad actors who are abusing this system for gain. We learn from a new federal watchdog report that Medicare paid more than $50 million in potentially improper bills from ambulance companies for questionable rides. Either the ambulance rides should not have been covered by Medicare or they never occurred.
The Inspector General (IG) at Health and Human Services (HHS) analyzed the claims data for 7.3 million transport rides during the first half of 2012. To understand the claims they looked at multiple aspects of Medicare-sponsored ambulance rides including transport destinations, distance of urban rides, transport levels, other services received, and geographic locations where the beneficiaries resided.
The IG found that Medicare paid $24 million in unjustifiable transportation expenses such as noncovered destinations including doctor’s offices (Medicare paid $17 million). In addition, Medicare paid $30 million for transports where no services ever happened.
And then there are the billers themselves. About one in five suppliers submitted questionable billing and that was geographically concentrated in several cities – more than half of all questionable transport were provided to recipients in four metropolitan areas: Philadelphia, Los Angeles, New York and Houston. That suggests that fraudulent ambulatory service companies in these areas are working together or at least are working on the same knowledge of how to game the system.
The Washington Post reports:
Together, investigators found, those and other suspect reimbursements accounted for one in five of the nearly 16,000 ambulance services nationwide that transported Medicare patients during the first half of 2012.
Previously, government investigators found that Medicare’s spending on ambulance services doubled to $5.8 billion between 2003 and 2012. The new findings are based on an analysis of Medicare’s billing records for 7.3 million ambulance rides in 2012. The findings suggest that “inappropriate and questionable billing for ambulance transports continues to pose vulnerabilities” to Medicare’s financial integrity, the report concludes.
The inspector general’s inquiry found that bad billing by ambulance companies remains concentrated in certain parts of the country…
And for companies with an especially large share of problematic bills, the average distance billed for ambulance transport in urban areas was 34 miles – more than three times the average trip for Medicare patients in urban areas.
Government social programs are breeding grounds for waste and fraud. When we expand them without ensuring that systems are in place to identify and root out such wrong doing, government creates enticing loopholes for scammers to take advantage of. At least HHS is trying to do something about it:
The Centers for Medicare and Medicaid Services, an agency within HHS, “is pursuing a comprehensive strategy comprising of several initiatives to combat ambulance transport fraud and abuse,” said spokesman Aaron Albright. In the past two years in Houston and Philadelphia, he said, the agency has blocked new ambulance services from participating in Medicare. And under an experiment to try to control fraud, the agency now requires advance permission in Pennsylvania, New Jersey and South Carolina for repetitive ambulance rides in cases that are not emergencies.
For the sake of those who truly rely on these services and our tax dollars, weeding this stuff out needs to be a priority for HHS. That’s what the IG report found, let’s hope they take this seriously and go after the fraudulent companies to send a clear message.