The Department of Health and Human Services Office of the Inspector General is estimating that Medicare incorrectly paid nearly $850,000 for emergency ambulance transports from hospitals to skilled nursing facilities.
A new report by the OIG analyzed whether Medicare payments independent ambulance suppliers and hospital-based ambulance providers for emergency transports complied with federal requirements.
The agency reviewed 8,800 ambulance claim lines from 2015 through 2017 and selected a random sample of 99 for analysis. The watchdog found that Medicare contractors made incorrect payments for 86 of them, which totaled $9,563.
The agency extrapolated that providers therefore incorrectly billed for emergency ambulance transports from hospitals to SNFs on 99% of claim lines (8,791 out of 8,800) and Medicare paid $849,170 in incorrect payments.
“If the rate of incorrect billings in our sample had continued through CY 2018, the year after our audit period, we estimated that Medicare would have made an additional $119,548 in incorrect payments,” the report stated.
The OIG report recommended that the Centers for Medicaid & Medicare Services develop a fraud prevention model for emergency ambulance transports from hospitals to SNFs to ensure that payments for these claims comply with federal requirements.
“If CMS had had oversight mechanisms in place, such as a fraud prevention model, it would have reduced the number of claim lines that providers incorrectly billed and the resulting overpayments we identified,” the report stated.