Federal Regulators Target Ambulance Service ProvidersJune 10, 2011 – Articles EMS World
Government investigation into alleged fraud and abuse by ambulance service providers is at an all-time high. According to one study commissioned by the Office of Inspector General (OIG), "25 percent of ambulance transports did not meet Medicare's program requirements, resulting in an estimated $402 million in improper payments." In response to what is perceived as an over-billing crisis, the federal government set up special task forces whose primary mission is to fight Medicare fraud and abuse. These task forces are extremely well-funded and have initiated thousands of investigations throughout the country, leading to numerous indictments in virtually every Medicare region. According to a press release issued by the Department of Justice (DOJ) and U.S. Department of Health and Human Services (HHS), efforts to combat healthcare fraud are actually turning a significant profit for the U.S. government. At least one report suggests the government's efforts are yielding a 6:1 return on investment, meaning the government recoups as much as six dollars for every dollar spent on enforcement.
In recent months, Philadelphia has seen its share of ambulance-related prosecutions. On February 10, 2011, the U.S. Attorney for the Eastern District of Pennsylvania unsealed an indictment against three individuals associated with Philadelphia-based Advantage Ambulance Company. The indictment alleged that Advantage overbilled Medicare by $1,268,000 over the course of six years by transporting patients who did not require ambulance transport. In a similar case, the U.S. attorney charged the owner of Gray Eagle Ambulance in Philadelphia with Medicare fraud for transporting patients who were able to walk or travel by paratransit van.