News

A RECENT FEDERAL AUDIT HAS UNCOVERED THAT IN THE FIRST SIX MONTHS OF 2012, $30 MILLION

A federal audit uncovers millions in Medicare spending on ambulance transports that lacked proper documentation, shedding light on potential misuse.

DJ
RCM Manager · 24/7 Medical Billing Services
Published October 3, 2015 1 min read

A recent federal audit has uncovered that in the first six months of 2012, $30 million was billed to Medicare for some ambulance transports later termed "mystery rides" because agents could not determine whether the patient had actually received any medical care after the purported ambulance ride.

"[They're] mystery rides because we don’t have any information in our files, in Medicare files, to show what medical service the person received, of if they received a medical service," said Suzanne Murrin, deputy inspector general at the U.S. Department of Health and Human Services. "Certainly, Medicare was not billed for a medical service, either on the way, where the person left or where the person arrived at."

Millions Lost Yearly to Ambulance Companies Acting Like a 'Taxi Service'

Medicare Funds Totaling $60 Billion Improperly Paid, Report Finds

The audit, conducted by HHS' inspector general's office, dug into Medicare claims for 7.3 million ambulance transports from the first six months of 2012. Medicare pays for ambulance rides for patients to see their doctors, if there is a medical need like the patient cannot walk.

The audit found that $24 million also had been paid out by Medicare "for ambulance transports that did not meet certain program requirements to justify payment."

"I think what we are finding is that there is a great deal of questionable billing, and there is a great deal," Murrin said. "This is still a program that needs further action to address weaknesses."

Philadelphia and Houston are trouble spots but investigators say Los Angeles and New York should be added to the list.

The Centers for Medicaid and Medicare Services told ABC News recently that it was "strongly committed to eliminating fraud, waste and abuse in ambulance transports" and had put several initiatives in place to fight the problem since 2012.

Source: abcnews.com

Tagged
DJ
RCM Manager · 24/7 Medical Billing Services
Danny writes on specialty medical billing, coding compliance, and revenue-cycle strategy, translating complex CMS and payer rules into practical guidance for practice administrators and physicians.
Work with a specialty billing partner

Stop losing revenue to preventable denials

247MBS runs your billing on true specialty depth — clean coding, correct modifiers, and denials worked to root cause on every claim.

Request a Revenue Review or call +1 888-502-0537