# Dependable care ambulance shutdown-Los Angeles



## looker (Aug 12, 2015)

Dependable care ambulance base in Los Angeles  with 5 or 7 unit have shutdown. Rumor is that Medicare ruled that many of their transport were not medically justified and demanded money back. Basically bankrupting the company and forcing it to close.


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## toyskater86 (Aug 12, 2015)

any reliable sources? i wouldn't doubt it either way.


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## looker (Aug 12, 2015)

toyskater86 said:


> any reliable sources? i wouldn't doubt it either way.


Their parking lot is empty, no ambulance is there. Haven't seen a single unit since Saturday.


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## gonefishing (Aug 14, 2015)

They are gone.  More business will be going bye bye soon.


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## RedAirplane (Aug 14, 2015)

I'm not quite sure how IFT works, but what happens to the hospital calling for these transports when their ambulance disappears overnight?


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## luke_31 (Aug 14, 2015)

RedAirplane said:


> I'm not quite sure how IFT works, but what happens to the hospital calling for these transports when their ambulance disappears overnight?


Call the next company down the list. In Los Angeles county the hospitals and nursing facilities typically have a list of multiple companies they use.


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## gonefishing (Aug 14, 2015)

RedAirplane said:


> I'm not quite sure how IFT works, but what happens to the hospital calling for these transports when their ambulance disappears overnight?


You call another provider lol


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## Mufasa556 (Aug 14, 2015)

So even more ambulances will be available at the next auction?


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## looker (Aug 15, 2015)

Mufasa556 said:


> So even more ambulances will be available at the next auction?


Yes and this is probably beginning of the end of IFT as we know today. Basically since 07/8 a lot of ambulance companies been pooping up left and right and medicare been paying out all of those claims without much of hassle.This in the last few years have ended and they are cracking down hard.Basically you will have mostly those that have 911 contract left and they will also do real ift that do not have questions on justification.Rest of those patients will go by gurney vans which frankly today are at very short supply. This for sure will change in the next  few  years. Regulation regarding gurney vans also have to change.Anyone that is thinking of becoming emt should really make sure that is what they want to do as there will an extreme over supply of emt compare to available positions.


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## looker (Aug 15, 2015)

RedAirplane said:


> I'm not quite sure how IFT works, but what happens to the hospital calling for these transports when their ambulance disappears overnight?


You keep going down the list until you find the one is available/still in business.


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## triemal04 (Aug 15, 2015)

looker said:


> Yes and this is probably beginning of the end of IFT as we know today.


You mean that southern california might actually have to follow the rules?

You mean that southern californian EMS might actually take a step forward?

You mean that people that defraud the gov't will be held accountable?

You mean that people that defraud the public and customers will be held accountable?

You mean that EMT's and "ambulances" will be used more for their intended purpose?

These are all GOOD things...don't you agree?


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## looker (Aug 15, 2015)

triemal04 said:


> You mean that southern california might actually have to follow the rules?
> 
> You mean that southern californian EMS might actually take a step forward?
> 
> ...


I don't agree that a lot if it was fraud. Just because someone can walk today do not mean they can walk tomorrow.I had patient that could sit in wheelchair on the way to the dialysis center but couldn't on the way back. Is it fraud if we transported him both way on ambulance? Ambulance are used what they are designed for as they might only available options for people being lessor level such as gurney van not available/ not covered by medicare insurance.


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## johnrsemt (Aug 16, 2015)

I had quite a few patients that could sit in a wheelchair;  but needed oxygen on the way back from Dialysis (Never saw a WC van carry their own supply or O2).
Or the ones that like Looker said could drive or ride in a van/WC on the way to Dialysis but not on the way back.

How about the ones that tell the Nurses at the ED that they can't sit or stand?  but then at home they get up and walk away from the cot?  Who is at fault for that?  The nurse that trusted the patient or the crew that let him walk away from the cot.

And it is going to get worse:  Medicare stops paying for more ambulance transports:  Already they won't pay for a patient to go to the doctor by cot (the ones that can't sit or walk on their own).  So if a patient can't go to the doctor every 90-180 days for checkups or mild problems.  All of a sudden they end up at the ED for problems that could have been taken care of at the doctors office if they could have gotten there.
  A friend is fighting Medicare for his mother who lives at home, but is bed bound due to MS;  Medicare is refusing to pay for a 5 day hospital stay for pnuemonia because she didn't go to the doctor before it got too bad (but Medicare won't pay for an ambulance transport to the doctor).  So who is at fault for that?


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## gonefishing (Aug 16, 2015)

johnrsemt said:


> I had quite a few patients that could sit in a wheelchair;  but needed oxygen on the way back from Dialysis (Never saw a WC van carry their own supply or O2).
> Or the ones that like Looker said could drive or ride in a van/WC on the way to Dialysis but not on the way back.
> 
> How about the ones that tell the Nurses at the ED that they can't sit or stand?  but then at home they get up and walk away from the cot?  Who is at fault for that?  The nurse that trusted the patient or the crew that let him walk away from the cot.
> ...


This is where community Paramedicine is going to really shine.  With the Obama rates you can always carry a secondary private insurance for as low as $20 a month.
Also alot of Doctors still do home visits same with NP's.  Theres alot of patients that don't necessarily need to go to a doctors office.  They can be taken care of at home.


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## johnrsemt (Aug 16, 2015)

When I looked at ACA it said that you didn't qualify if you had Medicare or Medicaid;   so maybe that changed since the beginning


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## gonefishing (Aug 16, 2015)

johnrsemt said:


> When I looked at ACA it said that you didn't qualify if you had Medicare or Medicaid;   so maybe that changed since the beginning


It sure did.  I would look into it.


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## looker (Aug 16, 2015)

gonefishing said:


> This is where community Paramedicine is going to really shine.  With the Obama rates you can always carry a secondary private insurance for as low as $20 a month.
> Also alot of Doctors still do home visits same with NP's.  Theres alot of patients that don't necessarily need to go to a doctors office.  They can be taken care of at home.


What really needs to happen is for medicare to start paying for gurney vans.They can pay half as much and there will  be plenty of providers. Otherwise we will have 911 getting all of this calls because grandmother wasn't able to see her doctor and instead now must be admitted to the hospital instead.


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## triemal04 (Aug 18, 2015)

looker said:


> I don't agree that a lot if it was fraud. Just because someone can walk today do not mean they can walk tomorrow.I had patient that could sit in wheelchair on the way to the dialysis center but couldn't on the way back. Is it fraud if we transported him both way on ambulance?


Why actually, yes, as a matter of fact if you billed medicare or their insurance for both ends of the trip requiring an ambulance then IT IS fraud.  If you adjusted the documentation so that it appeared the person required an ambulance for both ends of the trip when they really didn't then IT IS fraud.  Thank you for admitting that you run a fraudulent buisness with illegal billing practices. 

You can attempt to justify your actions however you want and try to make yourself out to be the good guy, but the plain truth of the matter is that you, and all those who follow similar practices to you are defrauding the government, insurance companies, and individual people to line your pockets. 

Good buisness plan if you can get away with it.


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## Akulahawk (Aug 18, 2015)

triemal04 said:


> Why actually, yes, as a matter of fact if you billed medicare or their insurance for both ends of the trip requiring an ambulance then IT IS fraud.  If you adjusted the documentation so that it appeared the person required an ambulance for both ends of the trip when they really didn't then IT IS fraud.  Thank you for admitting that you run a fraudulent buisness with illegal billing practices.
> 
> You can attempt to justify your actions however you want and try to make yourself out to be the good guy, but the plain truth of the matter is that you, and all those who follow similar practices to you are defrauding the government, insurance companies, and individual people to line your pockets.
> 
> Good buisness plan if you can get away with it.


It's only fraud if the initial trip is billed as requiring an ambulance (in that particular instance). If the initial run is billed as a gurney trip or wheelchair trip, and on the return trip the patient is evaluated/documented truthfully as requiring at least BLS monitoring, then the return trip would be OK to bill as an ambulance trip. However, doing that will invite extra scrutiny as the insurance company may question why the patient was OK for one type of trip before and another after a given appointment.

I have done many, many trips in the ambulance where the patient was "only" a wheelchair trip and was billed as a wheelchair trip, even though the ride itself was provided in an ambulance. This was done only in instances where our wheelchair vans were too overbooked to accommodate a given trip.


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## CALEMT (Aug 18, 2015)

Akulahawk said:


> It's only fraud if the initial trip is billed as requiring an ambulance (in that particular instance). If the initial run is billed as a gurney trip or wheelchair trip, and on the return trip the patient is evaluated/documented truthfully as requiring at least BLS monitoring, then the return trip would be OK to bill as an ambulance trip. However, doing that will invite extra scrutiny as the insurance company may question why the patient was OK for one type of trip before and another after a given appointment.
> 
> I have done many, many trips in the ambulance where the patient was "only" a wheelchair trip and was billed as a wheelchair trip, even though the ride itself was provided in an ambulance. This was done only in instances where our wheelchair vans were too overbooked to accommodate a given trip.



This. While working BLS IFT (at a different company) we would get "gurney runs" or "wheelchair runs" all the time. I was in a BLS ambulance and the gurney or wheelchair pt would get transported by ambulance. But heres the "catch" if you so desire to call it that, we wouldn't do a assessment, vitals or anything pertaining to a billable _ambulance_ transport. The only documentation done for these types of calls was a little sheet of paper (I'm trying for the life of me to remember what was on it) with the persons name, where we picked them up and where we dropped them off. If I remember correctly, we would get a signature for ex. the nurse at the dialysis center or the nurse at the SNF. There was no PCR created because this isn't a billable call for the ambulance side of things. 

Now for instance lets just say a gurney (non BLS pt) goes to dialysis and requires an ambulance back to wherever it is they came from, then yes we would bill for a ambulance ride. We had to state why they were returning by ambulance instead of a gurney van so we could justify billing insurance for ambulance transport.


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## gonefishing (Aug 18, 2015)

triemal04 said:


> Why actually, yes, as a matter of fact if you billed medicare or their insurance for both ends of the trip requiring an ambulance then IT IS fraud.  If you adjusted the documentation so that it appeared the person required an ambulance for both ends of the trip when they really didn't then IT IS fraud.  Thank you for admitting that you run a fraudulent buisness with illegal billing practices.
> 
> You can attempt to justify your actions however you want and try to make yourself out to be the good guy, but the plain truth of the matter is that you, and all those who follow similar practices to you are defrauding the government, insurance companies, and individual people to line your pockets.
> 
> Good buisness plan if you can get away with it.


Welome to Los Angeles.


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## triemal04 (Aug 18, 2015)

Akulahawk said:


> It's only fraud if the initial trip is billed as requiring an ambulance (in that particular instance). If the initial run is billed as a gurney trip or wheelchair trip, and on the return trip the patient is evaluated/documented truthfully as requiring at least BLS monitoring, then the return trip would be OK to bill as an ambulance trip. However, doing that will invite extra scrutiny as the insurance company may question why the patient was OK for one type of trip before and another after a given appointment.
> 
> I have done many, many trips in the ambulance where the patient was "only" a wheelchair trip and was billed as a wheelchair trip, even though the ride itself was provided in an ambulance. This was done only in instances where our wheelchair vans were too overbooked to accommodate a given trip.


That's what I mean; it may be ok for one half of a roundtrip but if an ambulance isn't needed for the other half then LYING and saying it was would be fraud, and thus illegal.  Same if you were using an ambulance as a wheelchair van; if it was only billed as a wheelchair trip ok, but if it was billed as an ambulance run because that was what was used (even though it was not needed) that would be <drum roll please> illegal.  Justify it however you want, it is what it is.


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## looker (Aug 19, 2015)

triemal04 said:


> That's what I mean; it may be ok for one half of a roundtrip but if an ambulance isn't needed for the other half then LYING and saying it was would be fraud, and thus illegal.  Same if you were using an ambulance as a wheelchair van; if it was only billed as a wheelchair trip ok, but if it was billed as an ambulance run because that was what was used (even though it was not needed) that would be <drum roll please> illegal.  Justify it however you want, it is what it is.


Her is small issue actually big issue. Medicare do not cover gurney van/wheelchair van. So unless person have secondary insurance that cover wheelchair van, patient is screwed for A leg each time. Good luck finding provider that would be willing to take patient one way for free and only get paid for return trip.


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## SandpitMedic (Aug 19, 2015)

looker said:


> Her is small issue actually big issue. Medicare do not cover gurney van/wheelchair van. So unless person have secondary insurance that cover wheelchair van, patient is screwed for A leg each time. Good luck finding provider that would be willing to take patient one way for free and only get paid for return trip.


LOL... Well ****, "good luck finding someone who is willing to do things legally/honestly..."

Wow... Just WOW!.

I hope you go to prison.


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## looker (Aug 19, 2015)

SandpitMedic said:


> LOL... Well ****, "good luck finding someone who is willing to do things legally/honestly..."
> 
> Wow... Just WOW!.
> 
> I hope you go to prison.



There is multiple way of evaluating person without it being fraud. Just because someone can sit in wheelchair on the way to dialysis today do not mean they are same way tomorrow. etc. With that being said, IFT for dialysis business is dying slowly.


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## SandpitMedic (Aug 19, 2015)

looker said:


> There is multiple way of evaluating person without it being fraud. Just because someone can sit in wheelchair on the way to dialysis today do not mean they are same way tomorrow. etc. With that being said, IFT for dialysis business is dying slowly.


No... It's dying because they are cutting down on the FRAUD. What are you not understanding about that? I'm not going to argue with you. Clearly, you're part of the problem. I will be happy to see you shut down, fined, and imprisoned for taking advantage of patients, young EMTs, taxpayers, and society as a whole. A spade by any other name is still a spade; you've been exploiting the loopholes and running the scam with your unethical business practice for long enough... A plague on American society, contributing to the demise of the American dream. Maybe one day you'll do the honorable thing, if you catch my drift.


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## gonefishing (Aug 20, 2015)

Bro Care aka Pro Care just got its medicare conviction.  Back to East Europe for the owners but they will be back in a few years with a new ambulance company.


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## etoh5150 (Nov 23, 2015)

gonefishing said:


> Bro Care aka Pro Care just got its medicare conviction.  Back to East Europe for the owners but they will be back in a few years with a new ambulance company.




BroCare.... HAHAHAHAHA that's the funniest thing I've heard. All those Glendale companies need to go.


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