Medicare Ambulance Fraud
November 23, 2015
In September, the U.S. Attorney’s Office for the Eastern District of Pennsylvania charged the owner of a Philadelphia ambulance company with 15 counts of health care fraud for billing Medicare $1.25 million for unnecessary services. The indictment alleges the man recruited dialysis patients who needed three treatments a week, so he could transport them to and from appointments and bill Medicare for those services.
This scheme is not new; in fact, Philadelphia is earning a notorious reputation with federal regulators as a hotbed for Medicare ambulance fraud. It’s a surprisingly easy way for criminals to make money. Until recently, pretty much anyone who completed a safety course and had a driver’s license could start an ambulance company. Unscrupulous ambulance operators would start a business and pay small sums to passengers for their participation in the scheme. But now federal regulators have prohibited new ambulance companies in the greater Philadelphia area from applying to provide services to Medicare patients.
The Scope of the Problem
Philadelphia isn’t the only city where ambulance companies are gouging Medicare. In September, CBS News reported that Philadelphia, Los Angeles, New York and Houston are “breeding grounds” for ambulance schemes and together accounted for almost $15 million in Medicare billing for ambulance rides that have no affiliated medical records – no information about where a patient was picked up, dropped off, or what medical treatment was provided.
In its nationwide investigation, the U.S. Department of Health and Human Services found 46 ambulance service providers supplied no records for nine out of 10 rides billed to Medicare, and Medicare has paid $30 million for rides that lacked documentation. But that’s just one method of overbilling Medicare. Ambulance billing is up dramatically, overall, and it accounts for billions in Medicare payouts. Providers are billing for services that don’t meet Medicare standards or aren’t medically necessary – and sometimes, there’s no evidence to suggest any medical services were provided.
Greedy ambulance companies are essentially stealing money from the citizens of the U.S., whose payroll taxes help fund Medicare.
The U.S. Department of Health and Human Services took a cautious approach in its audit, investigating all the reasons records might be fuzzy, or lacking altogether. It wanted to rule out mistakes and procedural errors. The high-profile ambulance fraud cases in Pennsylvania were less mysterious, given the facts uncovered by the FBI.
In 2014, Philadelphia ambulance company Penn Choice was indicted for fraud, after federal authorities found the company had billed for transporting patients who didn’t need help. (Medicare pays for transportation when patients are not capable of transporting themselves to appointments).
Federal investigators witnessed patients climbing in and out of Penn Choice ambulances and sometimes sharing rides, which the provider would bill as two separate round-trips. The company would offer envelopes of money to passengers, knowing that people who were too ill to work would take the small sums to keep quiet and participate. Ambulance employees would also use their own cars to transport patients, but bill Medicare as if those trips were ambulance rides.
A Need for Reform
Ambulance fraud has illustrated why the Medicare program needs to be reformed. It’s intended to be a safety net for people who need it, not to line the pockets of greedy business owners. Hopefully, reforms will help Philadelphia remove itself from the list of cities known for this type of fraud.
If you have any questions about this topic or believe you have been a victim of fraud, the injury attorneys at Wapner Newman can help. For almost 40 years, we have been the trusted advocates for countless personal injury victims and their families throughout Pennsylvania and New Jersey. We offer risk-free consultations and work on a contingency basis, which means that we do not require you to pay any fees until we have secured a recovery on your behalf. We encourage you to contact us today by calling 1-800-529-6600 or filling out a free case evaluation form.