OIG: Medicare taken for a ride
Some ambulance companies and their clients have cost Medicare an estimated $104 million in unnecessary services, according to a new OIG report. This time, the agency focused on ambulance claims that didn't result in hospital or nursing home admissions or emergency department treatment. These "Group 7" claims accounted for 6.3% of all claims in OIG's sample
OIG found that 70% of Group 7 claims were routine transports for outpatient diagnostic tests or shuttles between nursing homes and doctors' offices. The agency concedes that the size of its sample was small, with just 30 Group 7 claims. But "the sample size is sufficient to show that more than half of the services in this group are medically unnecessary," regulators assert.
Ambulance companies interviewed for the study admit that "60% to 93% of their transports are non-emergency while 7% to 40% are emergency transports." Some blame nursing homes for calling them for routine transports, which the companies feel they have to accept "due to local medical standards and potential liability."
OIG recommends HCFA install prepayment edits to check the medical necessity of ambulance claims. But HCFA claims it's too busy trying to fix its payment systems before the 2000 computer crunch to divert resources to ambulance edits.