Did An Ambulance Company Take Taxpayers For A Ride?

MMiz

MMiz

I put the M in EMTLife
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Did An Ambulance Company Take Taxpayers For A Ride?

It's one of the most profitable private ambulance companies in the state. The privately owned Murfreesboro Ambulance Service is at the center of a federal investigation into Medicare fraud.

The company transports critically ill patients to and from doctor's appointments, but federal investigators said it acted like an overpriced taxi service -- fraudulently billing Medicare more than $430,000.

"Did you get rich ripping off Medicare?" investigative reporter Ben Hall asked the owner of the company.

"I don't know as I ever got rich. We made a good living by working long hard hours, " responded owner Woody Medlock.

Read more!
 
MMiz said:
Did An Ambulance Company Take Taxpayers For A Ride?

It's one of the most profitable private ambulance companies in the state. The privately owned Murfreesboro Ambulance Service is at the center of a federal investigation into Medicare fraud.

The company transports critically ill patients to and from doctor's appointments, but federal investigators said it acted like an overpriced taxi service -- fraudulently billing Medicare more than $430,000.

"Did you get rich ripping off Medicare?" investigative reporter Ben Hall asked the owner of the company.

"I don't know as I ever got rich. We made a good living by working long hard hours, " responded owner Woody Medlock.

Read more!
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Things like this is routine practice among ambulance services as is poor reimbursement practices by insurance companies. I'd love for every EMT-Paramedic to be required to work in billing as a part of the EMS experience. It's a real eye opener.:unsure:
 
Ofcourse they took the tax payers for a ride, thats what happens when you let the privates run things, is anyone really surprised here.
 
atropine said:
Ofcourse they took the tax payers for a ride, thats what happens when you let the privates run things, is anyone really surprised here.
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Privates my tush! I live in a community which runs ALS and believe me, we pay twice! First, there i s the 3+ mils we pay annually for EMS / Fire service then the FD has the nerve to charge again!! It's an insurance scam, a public rip off and it needs to be stopped. Even though our primary income source comes from this fire department, I have always been extremely vocal about the FD double dipping scam.
 
I work for the private industrial EMS sector, and I know that I, as an employee, am fairly compensated.

What other billing goes on, I don't know. I'd rather keep it that way most of the time.
 
I don't know if that agency was 911 or IFT or both, but this is an example of a horrible catch 22 that ALL types of ambulances are in.

"A recent federal study indicated one fourth of all ambulance transports nationally did not meet Medicare requirements. That amounted to more than $400 million in improper payments."

Duh. We all know that. What the article doesn't say is that the 4th medicare patient you pick up meets you in the entryway, bag in hand, complaining of elbow pain x1 week and REFUSES to consider going to the hospital any other way. They won't take a taxi, call a friend, or wait till the morning and call their bloody GP. They demand you take them, and that is that.

Or the nursing home that calls at 3am for a patient with idopathic "toe pain", and when you show up the RN hands you a PCS form, filled out, and tells you that you are transporting the pt, end of? (not kidding, really happened). The crew spent 10 minutes explaining that "unable to stand due to toe pain" was not a justifiable reason for an ambulance because the patient could be transported via wheelchair van in the morning since toe pain is not an emergency situation. Needless to say, we lost, and the pt was transported. Who is going to be accused of fraud for that? My company or the RN?

So now we have Medicare on one hand saying "you're committing fraud!" and on the other hand we've got our employers, physician sponsors, and EMS councils stating "You can't refuse to transport a patient". What on earth are we supposed to do? Until it is legal for us to refuse to transport someone how can Medicare say "if it doesn't meet requirements, don't transport".

I also have to mention that if all those runs didn't meet requirements, how come Medicare payed? If they can prove that 1/4 of all ambulance transports didn't meet requirements then how come they paid for them? It sounds like Medicare also needs to work on their billing to prevent paying out in the first place.

I know that it is different when the person writing the report is intentionally falsifying what happened in order to make it meet requirements. I'm talking about the people not trying to intentionally defraud Medicare.
 
atropine said:
Ofcourse they took the tax payers for a ride, thats what happens when you let the privates run things, is anyone really surprised here.
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Right, because a service who does 70% EMS and 30% fire, but spends most of their annual budget on fire engines and fire supplies instead of new medical equipment isn't doing a disservice to their community.
 
Linuss said:
Right, because a service who does 70% EMS and 30% fire, but spends most of their annual budget on fire engines and fire supplies instead of new medical equipment isn't doing a disservice to their community.
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I agree lucky were not one of those departments, we just updated our whole ambulance feet two years ago and gurneys:P
 
Right, because powered cots have such an impact on pt outcomes.

How about putting that money towards more education so all your medics can interpret 12-leads amd do more interventions based off of such?


Or more intubation education?
 
Linuss said:
Right, because powered cots have such an impact on pt outcomes.

How about putting that money towards more education so all your medics can interpret 12-leads amd do more interventions based off of such?


Or more intubation education?
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Why I need that money for my Cancun trips.:P
 
for what its worth, i think the cots are an investment into the wellbeing of your employees

I agree that lifting technique is obviously important but I think everyone here will attest that sometimes it isn't enough...

That being said, I agree with your stance regarding more training towards personnel rather than spending money on other things that are used less often
 
I think you will see more cases like this. There was a similar one not too far from here recently http://emtlife.com/showthread.php?t=15114

I had a IFT for a company that could realistically did not have a medical basis for the transport. When I contacted dispatch with the information at the end of the run, I was told, "That sounds like a freebie, make it (the report) look like he needed ..."

I left the company a short time after that.
 
When I was a case manager...and when I worked ambulance....

As a case manager I could spot silly transports most of the time, but often when yo are a hundred cases in arrears and considering charges for ventilators, operations, etc., the ambulance trip slips by.

Having worked for two services, one completely private and another heavily subsidized, plus managed a two unit "fleet" in the Guard, ;), the cost of running an ambuance is quite high, especially when you consider insurance. Trip-based (X number of trips per month) averaging of amortization makes for higher costs for all. Time-averaged makes it more expensive for the users with longer calls. Charging strictly for level of care and equip/supply use yields horror stories about sixty dollar gauze sponges.

The tax-plus-fee deal works if there is no bilking. Stop responding the whole dept for EMS calls, the cost per run increase goes ballistic. Stop trying to use fees to discourage patients, but offer a less expensive alternative for getting to medical care.

Did they rip off taxpayers? What was their intent? Does their financial picture exhibit personal windfall profits? Or was any extra income put back into the corporation to better serve customers?
 
Aidey,

At the company I previously worked for, we were able to refuse transport for nursing home transfers, dr. appointments, and the like if the patient did not meet medicare requirements which were printed on the back of our PCRs. If the patient did not meet criteria for transport but wanted to go by ambulance anyways they could pay up front. Upon hearing the price, most chose to call family to take them to their various appointments (people always expect something for nothing). Even if a nurse demanded the patient be transfered, it was out policy to refuse in non-emergency transports that did not meet medicare requirements.

Now, there is a saving grace for some of these patients that lived in Los Angeles County. Los Angeles County actually opts to tax its citizens and spend some of that money on paying for ambulance transports for patients who do not meet criteria for medicare reimbursement. Typical LA Access transports included picking up "patients" in Lancaster and drive them down to Harbor City to a county hospital to receive their prescriptions or doctors notes, and than drive them back up tot he high desert. These transports were about 70 miles each way and the patients are ambulatory, AOX4, and in no acute distress. In fact, most of them could (and do) drive or have family that could drive them. These transports are handled by private companies who are paid to take these calls by the County.

I think the problem lies in that we just need to stop bringing people to dialysis or doctors appointments or back home in ambulances staffed with EMTs and paramedics. We are not trained to do the job, and the use of emergency vehicles is inappropriate. Lets start using litter vans and CNAs.
 
flhtci01 said:
I had a IFT for a company that could realistically did not have a medical basis for the transport. When I contacted dispatch with the information at the end of the run, I was told, "That sounds like a freebie, make it (the report) look like he needed ..."

I left the company a short time after that.
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This is typical in the Los ANgeles area.
 
daedalus said:
I think the problem lies in that we just need to stop bringing people to dialysis or doctors appointments or back home in ambulances staffed with EMTs and paramedics. We are not trained to do the job, and the use of emergency vehicles is inappropriate. Lets start using litter vans and CNAs.
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Nooooo...let's start using litter/wheelchair vans and NON-MEDICAL drivers. Seriously, how many of these people actually need someone (with more training than maybe a CPR card) watching over them? Answer: very, very few. If someone needs a ride to a dialysis/MD's appointment and that's all...get them an appropriate taxi. Medical transport shouldn't be used unless it truly is needed, and, as is happening here, if it's used wrongly, dealt with harshly.

One of the ways to start changing the system is to crack down on the abuses and unnecessary uses of it.
 
triemal04 said:
Nooooo...let's start using litter/wheelchair vans and NON-MEDICAL drivers. Seriously, how many of these people actually need someone (with more training than maybe a CPR card) watching over them? Answer: very, very few. If someone needs a ride to a dialysis/MD's appointment and that's all...get them an appropriate taxi. Medical transport shouldn't be used unless it truly is needed, and, as is happening here, if it's used wrongly, dealt with harshly.

One of the ways to start changing the system is to crack down on the abuses and unnecessary uses of it.
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Not a bad idea, but its not like we would have to pay the CNAs a whole lot anyways. They are the nursing equivalents of EMT-Basics.
 
daedalus said:
Not a bad idea, but its not like we would have to pay the CNAs a whole lot anyways. They are the nursing equivalents of EMT-Basics.
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That doesn't matter (it's not like the average wheelchair van EMT or strict non-emergency transport EMT get's paid much either); they could work for $0.25/hr and it still wouldn't be right. It's not a pay issue, but a misuse/abuse of a resource issue. While there are some people who, because of a chronic condition or maybe some other reason might need medical supervision during a scheduled trip to an appointment or discharge from a hospital, the vast majority don't. So why do we insist on using medical personnel (and this would include CNA's if they were used, or RN's, docs, anything) in an unnecessary fashion? And fraudulent charging people/gov't for it?

I don't know if would violate JACAHO/EMTALA or any state/local/federal statutes if someone was sent out of the hospital, or to the hospital/appointment with non-medical personnel; I doubt it in most situations. If it does...then it needs to be changed. People should not be stuck with something that is unnecessary, and then billed for it.
 
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