In response to rising Medicare Part B payments for ambulance transports and continuing concerns about program vulnerabilities, the OIG has once again reviewed Medicare claims for ambulance services. The OIG estimates that Medicare made $24 million in payments during the first half of 2012 for ambulance transports that did not meet certain Medicare program requirements (e.g., transports went to noncovered destinations). In addition, Medicare paid $30 million for transports that did not involve the beneficiary receiving any other Medicare services at the pick-up or drop off locations. Approximately 21% of ambulance suppliers exhibited at least one questionable billing practice during this timeframe, such as excessive mileage for urban transports or high number of transports per beneficiary. Such questionable billing was geographically concentrated, with more than half of the questionable transports provided to beneficiaries in four metropolitan areas (Philadelphia, Los Angeles, New York, and Houston).
The OIG recommends that CMS: (1) determine whether a temporary moratorium on ambulance supplier enrollment in additional geographic areas is warranted, (2) require ambulance suppliers to include the National Provider Identifier of the certifying physician on transport claims that require certification, (3) increase monitoring of ambulance billing, (4) determine the appropriateness of claims billed by ambulance suppliers identified in the report and take appropriate action; and (5) Implement new claims processing edits. CMS generally agreed with the recommendations, although the agency will review data before committing to new claims edits. For more information, see the full report, Inappropriate Payments and Questionable Billing for Medicare Part B Ambulance Transports.