Has anybody heard about the FBI raiding and arresting of 107 people across the US for medicare fraud? I read in one of the articles that Alpha Ambulance based in Los Angeles, CA was one of the ambulance companies that was raided, including four ambulance companies in Houston, TX.
Medicare Fraud
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Ha! Beat you to it! 
mycrofft
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bstone
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I read about it today. The article mentioned ambulance services fraudulently billing Medicare for transports that did not require an ambulance.
jjesusfreak01
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In their opinion...
This is the problem. At least where I live, ambulance transports require a physician or a nurse to sign off on it as medically necessary. It should never be the responsibility of an EMT Basic or a dispatcher with no medical training to determine whether a patient should be transported by stretcher. I like to think i'm good at it, but realistically, there are thousands of reasons that someone would need stretcher transport, and if a doctor says they do, it shouldn't be on me or my company for billing for that transport.
mycrofft
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Person on the scene and the pt need to decide on service and transport, but they can't decide how to bill it.
that describes every private ambulance company i ever worked for, even the most reputable agencies.
PotashRLS
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Spot on.
All our nursing home transports are initiated by a 911 call from the nursing home. They almost always have a prescription for transport by ambulance. The medical necessity should fall on the nursing home and the patient's physician and not the transporting agency. As a 911 provider, we have no choice but to respond and transport (most residents can no longer make decisions for themselves).
mycrofft
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I often wonder (well, not too often) how well ambulance and other "smaller" agencies understand billing to Medicare etc.
A case manager may make a decision whether to pay your , ask for supporting materials, or deny you, but if they mistakenly pay you and an audit shows you actually did not have grounds for payment, they aren't going after the case manager's pay to reimburse it...
What percent of these cases will turn out to be screwups by ambulance billing which found a formula that seemed to guarantee payment and started rubber-stamping it?
A case manager may make a decision whether to pay your , ask for supporting materials, or deny you, but if they mistakenly pay you and an audit shows you actually did not have grounds for payment, they aren't going after the case manager's pay to reimburse it...
What percent of these cases will turn out to be screwups by ambulance billing which found a formula that seemed to guarantee payment and started rubber-stamping it?
PotashRLS
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That is why you have a professional billing company do your ambulance billing. They are fully insured and liable for their services.
I have seen the fraud perpetuated by both ends for a number of reasons. Some actually admirable.
(recently I met a doctor who was laughing at the idea of "Robin hood" stating everybody robs from the rich, it is pointless to rob from the poor)
Anyone who has been at this game for any length of time knows the problem is largely the system.
It costs a crazy amount of money to do IFT with ambulances requiring emergency persons and equipment of a 911 vehicle while getting paid less than 1/2.
But there a few alternatives. Wheel chair transport gets even less.
I have seen doctors sign medical necessity forms (with the most bogus reasons) simply because if they didn't nobody would help the patient.
I have been coached even threatened to use "magic words" by every private employer I have ever worked for. I was even threatened to a point where I was making up information I didn't have. I later learned this same company asked my partner to rewrite some of my run reports after I had left the company.
My most notious story is from a vagrant patient who didn't even have ID, much less a permanant residence we picked up 911 for suicide.
I had no address and the company threatened to withold my pay, write nasty things in my file, etc. until I just broke down and made up an address to placate them. (It was the building we picked her up in front of)
When I brought it to the attention of the the VP, even he seemed to think I should somehow have gotten a billing address on the homeless person. Suggesting I should go to the hospital and ask the patient again.
There are probably more than a few organizations in EMS that barely scrape by. Still more with such cashflow issues that unless they get a rubber stamp on a billing claim will be in serious trouble.
I am sure there might even be a small handful of outfits that are purposefully frauding the system. (Most of which I would guess have some kind of organizational links with a history of such practices in retirement funds and union dues because of the complexity of the crimes)
But the problem isn't going to be solved simply by hunting down the few malicious frauds.
It will be solved by mandates and reimbursement schedules that don't make it impossible for a reputable company to make a buck on time without having to resort to gaming the system.
Amberlamps916
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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.
jjesusfreak01
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Wheelchair transports need to be covered by insurance companies. Period.
mycrofft
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Fix the system? But it's so much easier to scapegoat, point the finger, call in the villagers and go get them.
Use the Russian Quid Prop Quo: "If you pretend to pay me, I'll pretend to work"
Use the Russian Quid Prop Quo: "If you pretend to pay me, I'll pretend to work"
Unfortunately we are in a catch-22. We are expected to treat and transport everyone without caring whether or not they can pay. At the same time, the government doesn't want to pay for the times we transport someone who doesn't need an ambulance.
It should be pretty simple...someone calls for an ambulance and we transport them, after which we get paid.
It should be pretty simple...someone calls for an ambulance and we transport them, after which we get paid.
You are such a dreamer...
But there is also the issue of the minimum standard of care keeps going up, which means more expensive equipment, more training, etc. but the reimbursement doesn't go up.
I also still maintain IFT should be a seperate billing schedule, equipment, and staffing requirements than a 911 ambulance. (much less for all of these things)
mycrofft
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It would be interesting to see how many trips an ambulance needs to make (average actual pay received per trip versus amortization, insurance, fuel, and upkeep) before it is paid off and starts making money? (This is ignoring personnel costs, costs of housing and controlling the ambulances, licensing, etc.).
Possibly this is a field where, unless you cheat or cheapskate it, you can't make enough money. If so, we need to stop paying and permitting lowball artists and make primary transport and response civil service, the true and original reason for creating a civil service in the first place.
Possibly this is a field where, unless you cheat or cheapskate it, you can't make enough money. If so, we need to stop paying and permitting lowball artists and make primary transport and response civil service, the true and original reason for creating a civil service in the first place.
Perhaps 911 EMS should be a City or County level Public Service, leaving the IFT's to private contractors.
Question: In how many other industries does the provider have to settle for charging less than cost? Do Plumbers, Electricians, or Mechanics, just to name a few, have to settle for charging less than the cost of doing business?
So, is EMS a Business or a Public Service? How can any Business be expected to survive if it is only able to recoup a percentage of it's billable costs?
Question: In how many other industries does the provider have to settle for charging less than cost? Do Plumbers, Electricians, or Mechanics, just to name a few, have to settle for charging less than the cost of doing business?
So, is EMS a Business or a Public Service? How can any Business be expected to survive if it is only able to recoup a percentage of it's billable costs?
Fine questions.
mycrofft
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Dunno, lets ask AMTRAK passenger, or US Postal Service, or anyone accepting or forced to accept MEDICARE or Medicaid. Or any small business trying to out-comnpete Walmart