One out of four ambulance transports did not meet Medicare requirements and should not have been paid by the federal program, according to the Department of Health and Human Services Office of Inspector General.
Nearly 25% of claims did not meet Medicare’s coverage requirements, resulting in $402 million in improper payments, the OIG report states.
The OIG, which reviewed ambulance claims from calendar year 2002, also found that coverage error rates were significantly higher for dialysis (27%) and non-emergency transports (20%). By contrast, emergency transports met Medicare requirements 93% of the time, according to the OIG report, “Medicare Payments for Ambulance Transports.”
The Medicare ambulance transport benefit pays for ambulance services only when transportation by other means, such as a taxi, private car or wheelchair van, would endanger the beneficiary’s health.
The OIG recommended that the Centers for Medicare & Medicaid Services implement “program integrity activities” designed to prevent improper ambulance payments, including provider education and closer scrutiny of non-emergency and transport claims.
The full report is available at www.oig.hhs.gov/oei/reports/oei-05-02-00590.pdf.
