This story relates abuse of ambulance services under Medicare.
The patient smoked cigarettes in the passenger seat of the ambulance every week, chatting with the driver while taxpayers foot the $1,000 bill to drive him four blocks for his dialysis treatment.
The routine was part of a $1.5 million scheme to defraud Medicare by Penn Choice Ambulance Inc., according to an indictment against the Philadelphia company. The case helps explain part of why Medicare paid $5 billion to ambulance companies in 2012, more than went to cancer doctors or orthopedic surgeons, according to newly released federal data.
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.
To read the entire article, go to Bloomberg.com
So, is this fraud by health care providers, fraud by patients or incompetent claim administration by Medicare? The answer is all three, but all you will read about is the “scheme to defraud Medicare by Penn Choice Ambulance Inc.”
A private insurer typically would require justification for the first ambulance trip let alone weekly trips, but not Medicare. Medicare just pays with the remote possibility of retroactive review for medical necessity.
Here is what a private plan says about transportation services:
(professional transportation services—ambulance and air ambulance from the scene of an accident—to the nearest hospital equipped to handle your condition or from one facility to another if required and medically necessary)
Medicare has a very liberal definition of eligible ambulance transportation to begin with, far more liberal than private insurance. In fact, it is so liberal there is plenty of room for interpretation. Read the description here.
QUINNSCOMMENTARY 