A recent Bloomberg article http://www.bloomberg.com * noted: “The U.S. Department of Health and Human Services has identified ambulance service as one of the biggest areas of overuse and abuse in Medicare — companies billing millions for trips by patients who can walk, sit, stand or even drive their own cars. “
“It’s a cash cow,” said Assistant U.S. Attorney Beth Leahy… “It’s basically like a taxi service except an extremely expensive one that the taxpayers are financing.”
“Federal regulators and investigators have ramped up efforts in the past year to fight ambulance fraud and overuse, with rides to dialysis centers one of the problem areas. HHS estimates Medicare overpaid ambulance providers by $314 million last year, a third of it for medically unnecessary claims to the U.S. government health program for the elderly and disabled.”
“A large amount of fraudulent ambulance spending is coming from rides to and from dialysis treatment, according to a Medpac report last year. Dialysis patients must get treatment three days a week for years while they await a kidney transplant, making them a predictable, stable source of revenue for fraudsters, Leahy said.”
“While Medicare will pay for a non-emergency ambulance ride for someone so ill they couldn’t get to their medical appointments or treatment any other way, it is not supposed to be used by patients who can walk, sit or ride in a wheelchair. Of the $5 billion Medicare spent on ambulance trips in 2011, $700 million was for rides to dialysis centers, a 20 percent increase since 2007, according to Medpac. Medicare could save more than $400 million a year if the states spending the most on ambulance rides per dialysis patient were brought down to the average levels, it said.”
“Once dominated by local fire departments, volunteers, or hospitals, ambulances are increasingly being operated by private companies as local governments outsource the service to cut costs……”,
“The American Ambulance Association “condemns Medicare fraud in any form” and supports preventive measures such as preauthorization for dialysis trips, a review for new providers of dialysis transports, and unannounced site reviews, the trade group said in a statement.”
* to read the full Bloomberg article “Medicare’s $5 Billion Ambulance Tab Signals Area of Abuse” By Shannon Petty, highlight and click on open hyperlink http://www.bloomberg.com/news/2014-04-24/medicare-s-5-billion-ambulance-tab-signals-area-of-abuse.html?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=12602330&_hsenc=p2ANqtz-9quS5Gsy35vQ7d2y54jkdUFw8irSMiVr8DeHbtfMBCgAL6YVQGo308wHVxUzbOzLi0frOKNH5ek55uTQ0XSvRyOqJqDIAnVP05Mcw4DVx8MUPnyZU&_hsmi=12602330
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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
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