Report says Medicare funds wasted on ambulance trips Health officials say firms frequently billed for unnecessary services

November 09, 1997|By NEW YORK TIMES NEWS SERVICE

WASHINGTON -- Federal investigators, having documented many instances of overbilling and false claims by ambulance operators, say that Medicare wastes hundreds of millions of dollars a year by paying for unnecessary ambulance services provided to elderly patients.

In a new draft report, June Gibbs Brown, the inspector general of the Department of Health and Human Services, said that ambulance companies frequently billed Medicare for "medically unnecessary transportation." In addition, the report documents how some ambulance companies falsified "destination information" and charged the government for supplies and services that were not needed or not provided.

The inspector general said that more than 100 providers of ambulance services had been cited for civil or criminal violations of Medicare laws in the past five years. Medicare's system of paying for ambulance services, she said, is so complex that it "encourages fraud and abuse and thwarts efforts to control expenditures."

Ambulance operators said that in its zeal to crack down on abuse, the Clinton administration would inadvertently reduce services to victims of heart attack, stroke and other medical emergencies.

About 10 percent of the 38 million Medicare beneficiaries use ambulances each year. Outlays have more than tripled in the past decade and now total $2 billion a year.

"Medicare payments for ambulance services appear to lack common sense," said the report, to be issued later this month.

Brown said that some ambulance companies billed Medicare for supplies even though their vehicles were "restocked free of charge by local hospitals." In some cases, she said, companies misrepresented the condition of patients, stating, for example, that women were bedridden when they actually walked from the ambulance into the hospital.

Moreover, Brown said, some ambulance companies have run up huge expenses by taking Medicare patients on regularly scheduled trips to kidney dialysis treatments three times a week. Federal investigators found that most of these claims did not meet Medicare guidelines for medical necessity because the patients could have safely used other means of transportation.

Federal investigators have repeatedly described the problems in confidential reports to top Medicare officials during the past three years. The government has increased audits of ambulance companies, but a Medicare official conceded that "we have no way of ensuring that we are paying properly for the services."

Congress this year required the secretary of health and human services to establish a fee schedule, with fixed payments for each type of ambulance procedure. But the fee schedule will not take effect until Jan. 1, 2000. Under the law, the secretary must negotiate details of the fee schedule with the ambulance industry.

David A. Nevins, executive vice president of the American Ambulance Association, which represents 750 companies around the country, said the rise in Medicare spending was a good thing because it reflected improvements in ambulance technology and service that were saving lives.

Pub Date: 11/09/97

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