A report released Tuesday by HHS' Office of Inspector General reveals Medicare's history of ambulance fraud continued in 2012, when it paid $30 million for rides in which the patients did not receive medical care at their pick-up or drop-off locations, or anywhere in-between.
Here are five findings from the report, which details the inappropriate payments and questionable billing for ambulance rides under Medicare Part B.
1. The report found Medicare paid $24 million just in the first half of 2012 for ambulance rides that did not warrant payment. Included in these payments were $17 million for rides to destinations that are not included under Medicare, such as physicians' offices or community mental health centers. Also included were $7 million in payments for levels of care that did match the destination, for example, billing for an emergency transport to a nursing home, rather than a hospital.
2. About 21 percent of suppliers used questionable billing practices, according to the OIG. Together, these questionable rides accounted for $207 million in the first half of 2012. Questionable billing includes clocking unusually high mileage for transports in urban areas.
3. Questionable billing was concentrated in four major metro areas. The areas rife with questionable practices were Philadelphia, Los Angeles, New York and Houston. These cities accounted for 52 percent of questionable ambulance rides and 18 percent of overall rides in the time period studied, accounting for $104 million of the $207 million in questionable bills.
4. Medicare Part B paid $5.8 billion for ambulance services in 2012. This is nearly double its bill for ambulance rides in 2003. CMS previously put temporary suspensions on enrolling new ambulance suppliers in two different cities due to the business' susceptibility to fraud.
5. The study is based on 7.3 million ambulance claims in the first half of 2012. The OIG looked into destinations, levels of severity of the patient, urban transport distances, services received and geographic locations.
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