Medicare’s $30M ambulance-ride mystery


One if the things I do in my new career is teach people how to document their ambulance reports. I’ve done quite a bit of modification to the Power Point that my boss gave me to keep in current and frankly, to keep my students from falling asleep during class. The “students” are all paramedics and EMTs with some degree of experience working in 9-1-1 systems. In other words, they are, as Rodney Dangerfield said a “Tough Room.”

Perhaps the most difficult part of my class is explaining to them why an accurate PCR is important for billing purposes. Just as their eyes start to glaze over or they start to turn to their smart phones, I bring up a short series of slides of ambulance services that have reached multi million dollar settlements with the federal government to dispose of allegations of Medicare fraud. Then I talk a bit about criminal penalties and how a few people have gone to prison. For some reason, that seems to get their attention, even if it’s not field level providers who get shipped up the river.

While perusing various news sites, none of them EMS related, I came across the article referred to in the post title.

Medicare’s $30M ambulance-ride mystery

WASHINGTON (AP) — Medicare paid $30 million for ambulance rides for which no record exists that patients got medical care at their destination, the place where they were picked up or other critical information.

The mystery ambulance rides are part of a bigger problem with Medicare payments for transporting patients, according to a federal audit being released Tuesday.

The Department of Health and Human Services’ inspector general’s office also found that some urban ambulance services got paid for an average distance of more than 100 miles per ride. That contrasts with a national average of just 10 miles for urban ambulance rides.

Four major metro areas seemed to be breeding grounds for ambulance schemes. Philadelphia, Los Angeles, New York and Houston accounted for about half of the questionable rides and payments. Medicare has barred new ambulance companies from joining the program in Houston and Philadelphia, and the report recommends a similar approach in certain other places.

If you are in EMS at any level, you should read this article. There is a link at the end of the article to the Inspector General’s report as well. That’s in case you have insomnia not relieved by Ambien or Ativan.

If you are in EMS at any level, you should pay attention to this part of the article,

Fraud costs the health care system tens of billions of dollars a year. Medicare is especially vulnerable because Congress requires the program to pay claims promptly in most cases. That has given rise to the frustrating condition that law enforcement officials call “pay and chase.”

The inspector general recommended that Medicare use its existing legal authority to require more documentation from ambulance companies and to give its billing contractors additional options to hold off paying claims that don’t seem to meet basic requirements.

While that is likely to be good for my employer and me personally, it means that there is going to be heightened scrutiny and reports that are already a pain in the ass to write are going to become more so.

Kind of makes me glad I retired when I did because I’ll be able to say that back when I worked Patient Care Reports were a clinical document, not just an itemized invoice.

You should also note that the investigators who work for the various Inspector Generals offices are federal cops. Which means that if you lie to them, you’ve committed a felony even if you haven’t committed an underlying crime.

If you’re a field provider, be careful what you write, especially if any of your bosses are pressuring to write in things you didn’t do or provide treatments that are not warranted by the patients condition. That means that doing a 12 lead EKG and IV on every patient with minor complaints after a vehicle collision is not going to fly.




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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.


    • Part of the problem is that most of the PCR systems out there are very difficult to navigate and complete. It’s only going to get worse as the federal government tightens the documentation requirements over the next few years. There will be lots of meaningless data fields required.

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