Ambulance Scheme to Defraud Medicare

REPLAY VIDEO
Your next video will start in
Pause

Recommended Videos

  • Info

  • Comments

  • VIDEO TEXT

April 24 (Bloomberg) -- Bloomberg’s Shannon Pettypiece reports on Medicare ambulance fraud with Mark Crumpton on Bloomberg Television’s “Bottom Line.” (Source: Bloomberg)

Choice ambulance.

How'd do the federal officials allege their gaming the system?

This is a particularly egregious case but not unusual.

They were outside the dialysis center.

They were waiting for patients who could walk and get to the treatment on their own.

They were telling them we can get medicare to pay for your trip to dialysis for free in one of our ambulances.

We all know ambulances are used for emergencies and people who are so ill they cannot get to their doctors appointment any other way.

This company was taking patients who could walk or sit and stand just fine, putting them in ambulances transporting them back and forth, and charging medicare, some cases more than a thousand dollars a week to give patients rides in their ambulances.

How widespread is this?

This is a particularly egregious case.

There was one man who used to smoke cigarettes in the front seat of the ambulance on his way back and sometimes they would have to patients in the ambulance in the back writing to their treatment and they would ill medicare twice for it.

This case was unusual but i talked to a person in philadelphia who has done six of these cases.

The department of justice has gone out and taken action against 12 different ambulance providers.

They estimate they overpay ambulance dividers by $300 million a year in excess payments.

Some of that is not necessarily fraud, but it is quite common in certain pockets of the country.

Is medicare doing anything about it?

And step up efforts to do increased inspections and put new harriers for ambulances to get certified.

They have put a moratorium on the market until medicare gets a handle about this issue.

It's relatively easy to start and and villains company which is surprising because you think of them like a hospital order straight home.

The barrier to entry is not big.

In this case, it was just started by russian immigrant doing going in a doctors office.

Why hasn't medicare done more about this and other forms of fraud?

Wax until recently, medicare serve what they call pay and shake.

They will pay you an after-the-fact they will make sure the claim was appropriate.

But that is after the fact.

One of the theories is that care is a politically sensitive program.

It involves seniors, seniors vote, and no one wants a senior going to the doctor.

Too much paperwork and too much hassle.

No one wants a senior getting the claim denied.

Medicare has been hands off.

Now there is a big push under the affordable care act to crack down on a lot of spending.

They are doing more about fraud, but it has been a sensitive area.

What about insurance earnings and any thing they have done on the affordable care act?

We are starting to see insight into who has signed up for this.

About 80% of people signed up pay premiums, so that will be good news for them.

There is a big question about whether people were actually going to play -- going to pay and not just sign up for the plants.

I have to ask you about the ambulance story, if you want to see it it is on bloomberg.com and the bloomberg terminal all stop -- bloomberg terminal.

When you saw these numbers were you as a loan away as everyone else will be when they see it?

I started looking into this because i didn't realize medicare spent $5 billion year on ambulances.

We recently got new data that breaks out how much it pays different doctors and service providers.

The only service area that gets more our cardiologists and ophthalmologists.

This excludes hospitals which are huge factor.

That surprised me and what made me look into where it's going.

The story is on bloomberg.com.

Coming up, bulldogs.

This text has been automatically generated. It may not be 100% accurate.

Advertisement

BTV Channel Finder

Channel_finder_loader

ZIP is required for U.S. locations

Bloomberg Television in   change