The HHS Office of Inspector General (OIG) issued a report (OEI-09-12-00350) on utilization of Medicare Ambulance Transport. Findings from earlier OIG reviews reported ambulance benefits were subject to fraud. In 1996, the OIG reported that two-thirds of ambulance transports did not result in hospital or nursing home admissions or emergency room care. In 2002, they found 25 percent did not meet Medicare program requirements, resulting in over $400 million in over-payments. In the same report they found 27 percent of transports to independent dialysis facilities did not meet coverage requirements. The OIG cited a number of recent cases of ambulance fraud.
In the current review, the OIG examined the Medicare Part B claims for ambulance transports and associated claims with these transports, as well as enrollment data for all Medicare fee-for-service beneficiaries. They determined the extent to which the utilization of ambulance transports changed dramatically from 2002 to 2011. They also described the characteristics of beneficiaries, suppliers, and transports. They also calculated the percentage differences since 2002. The OIG reported the following findings:
- Medicare ambulance transports increased 69 percent (from 8.7 to 14.8 million) from 2002-2011
- In 2011, Medicare payments under Part B for ambulance transports totaled $5.7 billion
- Increase in payments was caused by inflation and transition to the national fee schedule
- Continued growth in the utilization of transports has also contributed to the increase
- Beneficiaries receiving ambulance transports increased 34 percent versus 7 percent increase in fee‑for‑service
- Number of ambulance suppliers increased 26 percent
- Ambulance suppliers primarily providing basic life support nonemergency transports nearly doubled
- Number of dialysis related transports increased 269 percent; those with end stage renal disease used a growing and disproportionate amount of transports each year.
- Transports to and from hospitals increased at a significantly slower rate than dialysis-related transports, but represented a larger proportion of all transports
- All states experienced increases, however utilization changes varied widely by state
The overall conclusion was that Medicare Part B payments for ambulance transports have grown at a much faster rate than all Medicare Part B payments. They made no recommendations based upon their findings; however this is only one of a series of reviews related to ambulance services under development. What the study suggests is a continued interest by the OIG in emergency transportation and provides some data to assist in assessing the level of concern for fraud and abuse in this area. This could lead to some targeted audits and investigations.
Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.
Copyright © 2013 Strategic Management Services, LLC. Published with permission.