Regional and Federal arrests and court cases throughout the U.S. are currently on the rise as private medical transportation services are accused of bilking the Medicare and Medicaid systems. The following insights will assist health care and hospital administrators from feeding the issue.
Recently the New York Attorney General’s Office released a statement reporting the arrest of a private New Rochelle area ambulatory transportation company owner who was charged with stealing more than $200K by falsifying transportation requests in order to inflate monetary reimbursement by the Federal Medicare and Medicaid systems, an inflation rate of at least four times higher than actual costs. Attorney General Eric T. Schneiderman was further quoted in the online article as saying, “Medicaid dollars are meant to help our most vulnerable citizens, not line the pockets of businesses owners.” (The Office Of NY State Attorney General, “Westchester Medical Transport Company Owner Arrested On Felony Theft Charges In Medicaid Fraud“, http://www.ag.ny.gov/press-release/westchester-medical-transport-company-owner-arrested-felony-theft-charges-medicaid, The Office Of NY State Attorney General, July 2014)
Further, these instances of fraud are not symptomatic solely to the state of New York. A health care or hospital administer can simply Google “Ambulance Fraud” to yield nationwide occurrences across all major American cities. And at present, the only possible way to curb these occurrences are for said administrators to “safeguard” requests for ambulatory services starting with their own actions from their own departments and to report suspicious requests directly to the Federal Government Agencies.
Medical providers currently send requests for needed services for Medicare and Medicaid patients directly to the private service providers based on a patient’s condition. Upon completion of said services, the service provider then submits the paperwork for the requested services directly to Medicare for payment/reimbursement; a fairly straight-forward system.
In her online article “Medicare Tightens Non-Emergency Use Of Ambulances To Combat Fraud“, Lisa Gillespie explains, a three-year pilot program is being implemented in the states of New Jersey, Pennsylvania, and South Carolina which will require medical service requests be pre-approved by the Medicare/Medicaid system before actual services are needed. Gillespie writes, “The pilot is part of a move by Medicare to require prior approvals for services and equipment associated with a high incidence of fraud, such as wheelchairs, chiropractic visits and plastic surgery. Officials said the three states were selected based on “high utilization and improper payment rates.” According to Gillespie, if the pilot program proves successful, the program will be expanded nationwide. (Lisa Gillespie, “Medicare Tightens Non-Emergency Use Of Ambulances To Combat Fraud“, http://kaiserhealthnews.org/news/medicare-tightens-non-emergency-use-of-ambulances-to-combat-fraud), Kaiser Health News, December 1st, 2014)
In addition to stringent new rules and criminal punishment to “ambulatory fraud” offenders put in place by the Obama Administration, here are other possible steps, according to the U.S. Department Of Health and Human Services and The U.S. Justice Department, a medical provider can take to assist in the fight against fraud by private medical service providers —- CLICK HERE TO READ MORE AND FIND OUT HOW YOU CAN SAFEGUARD YOURSELF AGAINST FRAUD.