For years, federal officials have been trying to stamp out a pattern of fraudulent ambulance operators in Southeastern Pennsylvania.
This pattern occurs when one fraudulent ambulance operator shuts down only to have another — sometimes headed by a friend or family member — replace it.
Now, authorities appear to have found an effective strategy to help curb the problem, The Philadelphia Inquirer reports.
Since 2014, authorities haven't allowed new ambulance firms in the Philadelphia region to receive pay from Medicare, the publication notes. Additionally, all repetitive nonemergency trips — dialysis, for instance — must receive prior authorization, according to the report. Previously, ambulance companies simply had to bill Medicare and pretend they had physician certification that the rides were medically necessary.
The Philadelphia Inquirer states that the impact of the rules has been huge in the region, where federal data show Medicare's annual spending on basic ambulance services plummeted to $12.7 million last year from $55.4 million in 2010.
"We're never going to claim victory, but we think we did a good job of rooting out a lot of these fraudulent companies," Nick DiGiulio, special agent in charge of the Philadelphia regional office of HHS' Office of Inspector General, said, according to the report.
The Philadelphia Inquirer cites Pennsylvania Department of Health data, which show 83 ambulance firms — more than a quarter of the total in Southeastern Pennsylvania — have closed since 2014.
Overall, Mr. DiGiulio told the publication, after 30 criminal convictions in the last five years leading to an aggregate of 82 years in prison and restitution orders totaling $22 million, "we're not hearing as much about this fraud."
And improvement can be seen in other states as well. According to the report, in the three states where prior authorization has been required since 2014 — Pennsylvania, New Jersey and South Carolina — monthly Medicare costs for scheduled, repetitive ambulance trips plunged to an average of $5.4 million last year, in aggregate, from $18.9 million the year prior.
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