This week, the DOJ announced that North East Mobile Health Services of Scarborough, Maine, and Maine Medical Center, of Portland, will pay a total of $1.4M to settle claims that they fraudulently billed Medicare for medically-unnecessary ambulance transportation.
Since 2007, North East had been billing Medicare for stretcher-bound discharges from Maine Medical Center that could and should have been handled by much less expensive modes of transportation such as wheelchair van and medical car service.
They used the old “bed-ridden” distinction a bit too loosely and got themselves into trouble. They also allegedly knowingly kept overpayments from Medicare.
Both North East and the Maine Medical Center cooperated fully with the investigation.
Maine Medical Center, ambulance provider pay $1.425 million to settle Medicare fraud case - The hospital will pay $600,000, while North East Mobile Health Services, of Scarborough, will pay $825,000, to resolve allegations that both groups defrauded M... https://t.co/VL4OuFPJV7— Kennebec Journal (@KJ_Online) February 23, 2018
Here is yet another example of authorities cracking down on this long-abused caveat in our health system.
We asked Susan Delsandro, On Time's Executive Vice President about her take on these kinds of cases, and what they mean for the industry as a whole.
Susan oversees On Time Ambulance's compliance program and has presented to, and educated ambulance providers throughout the country.
What do you think is the key takeaway from all of these different instances of fraud by companies around the country?
I think it's that there are penalties for both organizations. Quite often the feeling is that there will be no repercussions for the facility and the facility is not concerned about what happens after the patient is moved. It’s important healthcare facilities realize they can also be held culpable when it comes to OIG guidelines and ambulance transportation compliance.
How are you making sure that this sort of thing never happens at On Time?
We do in-service compliance training with all of our facilities to explain that most discharges can go by wheelchair van and lower mode. We have twice as many wheelchair vans and cars than ambulances and ambulance transports make up just 20% of our transports.
Why is fraud so rampant around the country?
People hit the easy button, because Medicare “covers” stretcher service and does not cover lower mode. Unfortunately that means speaking to the patient or family member about having to pay for the service. Most hospital personnel are not comfortable having that money conversation, so they just order ambulance service. Companies should have trained customer care specialists that can explain to patients and families why they are responsible for payment. It’s all about taking the time to educate them.
What would be your advice to someone reading this thinking “wait a minute, my company is doing this!?”
They should immediately stop!! Both the facility and the transport company should seek legal advice. This certainly could be a qui tam or whistleblower area of weakness for both organizations.
John Bush & Susan Delsandro, On Time Ambulance
If you or someone you know is working in an environment where this practice is common, you should be aware of your options.
Here are two resources to get you started.
- How to Report Ambulance Fraud and Receive a Whistleblower Reward
- Is Your Company Submitting False Claims to Medicare or Medicaid?