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.
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.
The information below comes directly from Medicare Coverage of Ambulance Services, a free resource made available by Medicare.gov. Some emphasis has been added for clarity purposes.
Have questions about your specific Medicare transportation coverage situation in New Jersey? Contact us online or give us a call at
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The following information applies to all people with Traditional Medicare.
If you have a Medicare Advantage Plan (like an HMO or PPO) or another Medicare health plan, you have the same basic benefits, but the coverage can vary by plan.
In December 2014, new Medicare rules on ambulance transportation went into effect here in New Jersey.
CMS implemented the new rules to weed out fraud from ambulance companies billing Medicare for transportation on a stretcher in an ambulance when other, less costly methods would have sufficed. While many welcomed these changes, there have been some unintended consequences.
Significantly fewer ambulance companies exist in New Jersey today than a year ago. Estimates of the amount of closures range from 25 to 50 firms---with more likely closing in the future.
Some have closed their doors quickly without any advanced notice, leaving patients and their families in a dangerous limbo. This may seem strange, because health care is one of the fastest growing industries in the nation. So what’s causing the sudden closure of so many medical transportation providers here in the Garden State?