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Ambulance fraud keeps gouging programs


Ground ambulance services can pose a serious fraud threat as evidenced by recent cases and extended government moratoria on new ambulance provider applications in fraud zones.

There are four common elements of ambulance fraud and abuse schemes, according to former U.S. Department of Health and Human Services Inspector General Richard P. Kusserow: Recruiting Medicare beneficiaries for ambulance travel even though they can walk and therefore don't qualify for ambulance benefits, falsifying reports to make it appear that other forms of travel are contraindicated, paying illegal kickbacks, and overbilling Medicare by misrepresenting services provided.

Ambulance companies have claimed payment for services not provided or ordered by treating physicians, Kusserow noted. Fraudsters piled people into vans but billed for solo ambulance trips attended by emergency medical personnel. And some providers claimed patients were transferred by stretcher when they actually rode in the front seat of an ambulance, Kusserow wrote.        

In a representative case, Pennsylvania ambulance driver Valeriy Davydchik of Penn Choice Ambulance Inc. was sentenced to 24 months in prison for transporting beneficiaries by ambulance who could travel safely by other means, the U.S. Department of Justice announced Thursday. Davydchik drove people to medical appointments in his own vehicle, the announcement stated, and provided kickbacks for using his company. Penn Choice's billings resulted in a $1.5 million Medicare overpayment.

And Eddie Wayne Louthian Sr., former president of a Virginia rescue company, was sentenced to four years in prison and ordered to repay over $900,000 for bilking Medicare and Anthem Blue Cross and Blue Shield out of nearly $1 million, The Roanoke Times reported. Saltville Rescue Squad took patients back and forth for dialysis appointments by ambulance without a legitimate medical reason for such transport.

Growing Medicare ambulance payments have caught the eye of the Office of Investigations, Kusserow noted, which may result in more government crackdowns on emergency transportation benefits.                 

For more:
- here's Kusserow's commentary
- read the DOJ announcement
- see The Roanoke Times article

Related Articles:
CMS stops taking new provider applications in fraud zones
CMS reveals RAC audit hotspots
BCBS reimbursement policy costs ambulance firm $3M