[Update February 2019] We are presently involved in several Medicare and Medicaid fraud claims involving the EMS providers. The Centers for Medicare & Medicaid Services (“CMS”) believes that the EMS industry has one of the highest rates of fraud within the healthcare industry. The situation has become so dire that in many metropolitan areas, CMS has taken the unprecedented step of freezing new applications for ambulance services. That means that legitimate providers can’t even expand because there is so much fraud that the auditors can’t keep up with the existing providers.
Common themes of fraud within the industry include transporting patients despite a complete lack of medical necessity. Ambulance companies that cater to dialysis patients or who transport patients to and from nursing homes are often guilty of these fraudulent practices. Another type of fraud includes billing for advanced life support transports when only basic life support services were warranted or necessary. Yet another type of EMS fraud involves paying or receiving kickbacks from other healthcare providers.
Millions of dollars have been paid to whistleblowers in these cases and there is plenty more fraud that has yet to be reported. Non Emergency Medical Transportation programs are also rife with fraud. We have plenty of EMS fraud stories on our blog. For more information on ambulance fraud, kickbacks involving EMS and nursing homes, click here. For nonemergency medical transportation program fraud, click here.
Ed. Note: The author of this post, Brian Mahany, was quoted in VectorCare in February 2019. The article gives great background on EMS fraud.