Medicare Fraud

[Vladimir]

Oh My Gosh dude!!!

So I saw at least one of you say that you guys committed fraud!!! WOW... The thing with this type of fraud is that it becomes a bigger crime with the intent, that you are currently admitting. The truth is that the thing that makes an ambulance service so prohibitively expensive is the 24/7 component, but even this can be mitigated by decent management. Medicare pays a decent amount, (not a huge amount, but decent) for transports. Privates are just that, private! So that means the company may have little money after the owner attempts to probably squeeze every penny out of the company at the end of the month.

SO with all that being said... STOP COMMITTING FRAUD!!!
You lie on a run sheet, you make some information up, you use "SPECIAL WORDS", you are rewriting for your employer, you are committing fraud! Is your job right now going to be your career? Is Ivan, Igor, Sebatian, Vladimir, or whatever going to have your back dude? no they will disavow you! This is a serious crime, so please do not commit it, you could potentially go to prison for it, geuss who investigates medicare fraud!!! The FBI!

So dont be a fool... stay in school.. lol


Your friendly neighborhood commentator,
Vladh34r:

 

[TatuICU]

I read about it today. The article mentioned ambulance services fraudulently billing Medicare for transports that did not require an ambulance.

To be fair, about 85% of calls do not require an ambulance. But we're legally obligated to take these gomers to the hospital wasting every everyone's time and money. So until they change the laws, I say companies have the right to bill the living crap out of everyone, including medicare.

 

[TatuICU]

My company just held a meeting over the "Magic words" for Medicare on the run tickets, complete with angry Armenian operations manager slamming his fist on the table, signaling that he means business. What a crock.

L-M-A-O!!!! Are you for real? How in the world did you or anyone else keep a straight face??? Or did you?

 

[Vladimir]

Report it

:excl::excl::excl:What company do you work for that you were told to use magic words?
I would say, REPORT that to both medicare, cms, and your local fbi office. if you are in los angeles, youll be probably assisting in an ongoing investigation.:excl:

 

[Veneficus]

:excl::excl::excl:What company do you work for that you were told to use magic words?
I would say, REPORT that to both medicare, cms, and your local fbi office. if you are in los angeles, youll be probably assisting in an ongoing investigation.:excl:

Are you kidding?

Even hospitals buy intake software designed to make you select from a dropdown box of "magic words."

They do so under the legal guise of "streamlining" billing information.

It is not fraud if it is true.

Grey, medicine is grey...

edit: and once word gets out you are making accusations of fraud, you will be the most moral unemployed and unemployable care provider ever.

 

[Vladimir]

Often Times...

Veneficus, I can agree with you to a certain extent, but not completely. Some companies go so far as to tell E.M.T.'s to write certain words that upgrades reimbursement, in order to get a higher billing code. I am not sure if you know anything about ambulance billing, but medicare pays more (than regular bls-ER calls) when emt-b's transport als-ER patients.
For example, chest pain for a rash on the chest that's painful (makes it ALS), shortness of breath if thats the regular for the patient (Makes it ALS), and so on and on...

Calling things a grey area, is like saying a white lie. You can not be one of those EMT's that makes an excuse to not do your job properly. I am not a fire groupie, or a ricky rescue type, but I know the way the "feds" (literally the fbi and cms) interview EMTs all the time nowadays in Los Angeles County, and probably all over the nation, it is time to review what you are doing. And also just because everybody does it, is not a good excuse. Do you know hospitals are getting (literally) raided too? These hospitals are not infallable... and also, I have no idea how familiar you are with billing software, but you have to use ICD9 and CPT codes, and simple sounding diagnoses have many codes sometimes and they get extremely specific.

 

[Vladimir]

One other thing...

EMT's are liable for what they write. If an EMT beleives there is being fraud committed, report it. You can also anonomously report it, it is your civic duty. Remember, you can be prosecuted if you commit fraud. They will also look at ALL of your patient care reports, and if an employer persuaded you to defraud the United State government, you still defrauded the United States government!

For example when Greybor ambuance was raided in 02, they followed every single ambulance, and went into their offices simultaneously and had everybody at gun point. Even EMT's taking showers were at gun point... And many people (mostly ownership AND management) went to prison.

 

[Amberlamps916]

It was really hard to keep a straight face.....

 

[Vladimir]

I can imagine... you work for elite (I think elite is armenian, maybe russian... but its one of those two for sure)huh? lol, because I think the other big armenian company was transaid before they had their issues... lol
These guys are so crazy man, they want people to do crazy things, and do not see an issue with any of it. I have been asked to change stuff on run sheets too, I just said I was in a hurry and left... they usually had my partners change paperwork probably. Thats why I always just drove. I even got fired once for not transporting a patient with the proper paperwork, they were refusing a call and had no 5150 and they were not on a conservatorship... one thing about this field dude is CYA!!!!! Cover Your A$$!

 

[Anjel]

What do you have against armanians?

 

[ffemt8978]

A word to the wise...leave the racial aspect out of this discussion.

 

[Vladimir]

Nothing

... when i said these guys, I meant ambulance company owners and management... not aremenians.

 

[jemt]

I'm not comprehending this clearly, all patients that are IFT transports require a form that states why they need to go by stretcher signed by a Dr., yet the EMT writing the narrative is also responsible for fraud if the pt. doesn't need to go by stretcher?

The last company I worked for required the EMT's to write the reason for BLS transport at the end of the narrative (reasons were provided for us).

 

[Veneficus]

I'm not comprehending this clearly, all patients that are IFT transports require a form that states why they need to go by stretcher signed by a Dr., yet the EMT writing the narrative is also responsible for fraud if the pt. doesn't need to go by stretcher?

The last company I worked for required the EMT's to write the reason for BLS transport at the end of the narrative (reasons were provided for us).

The classic EMS thinking.

Authority without responsibility.

In a nutshell, you are responsible for commiting fraud. A patient chart is a legal document, if you falsifying it knowingly, you can be held accountable.

Now having covered that. I am not sure I would try to use coercion as a defense. It has a history of not working in spectacular ways.

But I think you have to have some perspective...

I doubt the US attorney wants to put a bunch of minimum wage earning EMTs in federal prison.

They want big fish. Which may be your boss.

Inevitably there is no honor among thieves, They will point the finger at you, you will point at them.

But these questionable morals companies have you over a barrel. You have no markitable education in a saturated maket that is really trucking around human flesh for more money than it is worth.

You are better off in another field.

At best, you will testify against your former employer and be out of a job.

At worst you might be "an example" an attorney is trying to set.

 

[jemt]

I agree with all your points about how backwards IFT is, but I don't understand how a EMT could be held responsible for a pt. going by stretcher when its not needed.


Why/how is a EMT expected to know medicare guidelines for BLS transport?

I also dont understand how a brand new EMT who is told by his employer to go pick this patient up at this time and write what happens, is committing fraud.

 

[usalsfyre]

I agree with all your points about how backwards IFT is, but I don't understand how a EMT could be held responsible for a pt. going by stretcher when its not needed.


Why/how is a EMT expected to know medicare guidelines for BLS transport?

I also dont understand how a brand new EMT who is told by his employer to go pick this patient up at this time and write what happens, is committing fraud.

If you knowingly document SA reason that is not true and consistent with your assessment, it is fraud. Doesn't matter who told you to write what, where.

All we ask of our providers is to document accurately and completely and let someone else worry about getting paid.

 

[Veneficus]

I agree with all your points about how backwards IFT is, but I don't understand how a EMT could be held responsible for a pt. going by stretcher when its not needed..

Because you are writing the report that your employer is going to submit for payment.

It is based on your word if this patient does in fact meet the criteria for ambulance transport.

A doctor has to sign a need form also.

It is a check in the system.

Think of it like the movie crimson tide. the captain (doctor) gives an order.
The xo (you) have to verify that order.

If you falsely verify, you have commited a federal crime.

Now if your company is upstanding, they hire an expert and educate you on medicare billing, so you know what you can do and what you can't.

Some even buy software that only lets you select what you can and what you can't.

If your company is questionable or shady, they will tell you what to write. You may choose to do that, which implicates you as an accessory, or you can suffer ill consequences including termination.

Without your report and signature, aa bill cannot be submitted.

Why/how is a EMT expected to know medicare guidelines for BLS transport?.

Well, you can take responsibility and educate yourself or your employer may pay to have you educated. (fat chance on the latter) But if you are signing a legal document to get money from the federal government, you really may want to figure out what is acceptable and what is criminal.

I also dont understand how a brand new EMT who is told by his employer to go pick this patient up at this time and write what happens, is committing fraud.

Your employer does not set the standard on what is billable and what is not. But you are a check in the system to make sure that only appropriate patients get billed.

It is unfortunate that they do not spend time on the in EMT class, because most EMTs work in IFT, but the failure of the system is beyond our control.

If you write the patient couldn't sit in a wheel chair on your report and they can (for extended time) you lied.

If you write the patient is having chest pain and the patient is not, you lied.

This may come as a shock, but government officials, including police are permitted to lie to you, you are not permitted to lie to them.

Especially when it costs them money.

Now there are some caviats to what I wrote here, for instance if a patient cannot sit in a wheelchair for an extended period. (which is a bit subjective) Then they do qualify.

I know doctors who sign those forms without reading them or have their underlings sign them just to open up bed space or because the patient cannot afford to pay for transport.

If you comply with such, write a legal document saying such, and your company submits a bill which is paid, it is like being the driver of the get-a-way car. You didn't do the robbing, but you are part of the scheme.

There are many less than honorable companies and even honorable ones that have exploited the system of payment over the years and still do. Now there is just a very visible crackdown on it.

 

[jemt]

I see the light now!

IF I lie on a narrative I'm committing fraud,but if I just write what happens I'm not committing fraud even if the IFT pt. doesn't need stretcher transport?

 

[Veneficus]

I see the light now!

IF I lie on a narrative I'm committing fraud,but if I just write what happens I'm not committing fraud even if the IFT pt. doesn't need stretcher transport?

exactly.

 

[jemt]

Thank you for clarifying.