This summer, the Centers for Medicare and Medicaid Services (CMS) released their long-awaited report on the effectiveness of their Prior Authorization program, which aims to weed out medical transportation waste, fraud, and abuse.
Last month, the Burlington County Times reported that the Delran, NJ Emergency Squad had its licensed suspended by the New Jersey Department of Health.
Their chief would ride a long and treat patients on a regular basis. What's wrong with that you ask? Nothing, except his EMT license had been expired since December of 2010.
To cover their tracks, the squad would then alter trip reports to claim that only credentialed employees had done the runs.
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 their inception in March 2007, The Medicare Fraud Strike Force, a joint initiative between the DOJ and HHS, has charged defendants who together falsely billed more than $7 billion to federal healthcare programs. Through payment data analysis, investigations, and coordination with CMS, they are working diligently to stop fraud, abuse, and other healthcare crimes. A provision in the Affordable Care Act provided an additional $350 million in annual funding allowing the Strike Force to expand from two cities to nine. Here are some of their most eye-popping, remarkable, and unsettling busts.
It seems like this phenomenon pops up in the news every week. Medical transportation is one of four major drivers of Medicare and Medicaid fraud. Some providers will attempt outrageous stunts to bill our health care system for expensive services. Below are a few examples from here in New Jersey and around the country.