Federal Regulators Target Ambulance Service Providers

June 10, 2011Articles 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.

View entire article