L.A. Center of Bad Ambulance Billings
Is Los Angeles the fraudulent ambulance capital of the United States?
That was the conclusion of a new report by the U.S. Department of Health and Human Services Office of the Inspector General (OIG). The agency recently audited ambulance transports billed to the Medicare Part B program during the first half of 2012. According to the audit, some $207 million worth of payments were for ambulance transports did not meet all Medicare requirements, either for transports and returns that were non-covered destinations; for destinations where no Medicare services were rendered at all; or for excessive mileage in urban areas, among other issues.
Altogether, about one in five ambulance services that billed Medicare did so in a questionable fashion, according to the report, although it did not disclose the names of specific providers.
Although the Los Angeles area accounted for 4.7% of all of the nation's ambulance transports, it accounted for 15.2% of all questionable transports unearthed by the OIG audit. That tied for Philadelphia for the metropolitan area with the largest percentage of questionable transports.
However, Los Angeles accounted for $32.3 million of all the questionable ambulance transport billings nationwide, or about 15% of the total.
Los Angeles ambulance companies also received far higher compensation than ambulance providers nationwide. Los Angeles ambulance operators received an average of nearly $106,000 in Medicare payments during the first half of 2012, compared to slightly more than an average of $16,000 in payments elsewhere in the country.
It would not be the first time the Los Angeles area and Southern California were the necxus of questionable Medicare billing practices.
A prior OIG report found the region to also have a high volume of questionable home healthcare billings, and many businesses that billed Medicare but had addresses that did not exist or did not contain a home healthcare business.
The OIG made several recommendations, including a moratorium on having new ambulance companies join the Medicare program; documentation of the physician's national provider number when an ambulance rise is ordered; and increased monitoring of ambulance billings.
