October 6, 2015

One in five ambulance suppliers submitted questionable bills

Washington DC ambulance fraud whistleblower

A new federal audit found that many ambulance transports paid for by Medicare (and accordingly, by taxpayers) were questionable or improper.

Last month, the Office of Inspector General (OIG) released a detailed study of nearly 7.3 million ambulance transports billed to Medicare Part B in the first half of 2012 identifying millions of dollars of potentially inappropriate payments. According to the OIG report, approximately $54 million of inappropriate Medicare payments were made to ambulance transports under dubious pretences.

At least $24 million in Medicare payments were improper and not justifiable under Medicare billing regulations. Another $30 million in ambulance transport payments were questionable and billed for patients who received no Medicare services at all. The OIG estimates up to one in five ambulance service providers had questionable billing practices such as having an unusually high miles per transport average in urban areas.

As the federal audit points out, more than half of questionable transports discovered took place in four large metro regions. Hot spots of suspected fraud include Philadelphia, New York, Houston, and Los Angeles.

The OIG offered four recommendations to stem the widespread ambulance billing fraud:

  • Center for Medicare and Medicaid Studies should determine whether moratoriums on ambulance contractor enrollment are appropriate in additional geographical areas,
  • Whether ambulance transport contractors must enroll in the National Provider Identifier for certification,
  • To monitor ambulance billing more closely, and
  • Examine the legitimacy of claims submitted by ambulance transport contractors identified by the OIG to be suspicious.

The OIG’s report highlights what is already well known by those who study the issue: Medicare is extremely susceptible to fraud by contractors, hospitals, and unscrupulous physicians who take advantage of the system. Every year, billions of taxpayer dollars is siphoned from Medicare by perpetrators of fraud. One of the government’s most effective tools in combating fraud is whistleblowers stepping forward and filing qui tam lawsuits under the False Claims Act.

The Act allows private citizens with important inside information about fraud to work with an attorney to file a civil lawsuit on the government’s behalf. Whistleblowers who successfully prosecute their claim are entitled to receive between 15 percent and 30 percent (depending on the circumstances of the case) of the money recovered as a reward for their efforts. If you have important knowledge about companies, contractors, or individuals submitting false billing claims to federal programs like Medicare or Medicaid speak to a whistleblower attorney of The Cochran Firm, D.C. to see if you have a case.