By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On July 16, 2012, a New Hampshire city allegedly launched an audit into its primary ambulance service, American Medical Response (AMR), after the company acknowledged overbilling hundreds of patients since 2011, according to a Union Leader article.
AMR Allegedly Incorrectly Billed 323 Ambulance Trips.
According to the report, an in-house audit by the city showed that 323 ambulance trips out of nearly 5,000 in 2011 and 2012 had been incorrectly billed. This amounts to slightly more than six percent (6%). AMR attributes the overbilling to human error.
After concerns that the billing problems could be more widespread, it was decided the ambulance service should be audited by an independent auditor.
AMR is reported to have forgiven any outstanding incorrect balances and issued $16,000 in refunds to patients who had already paid the incorrect bills.
Patients’ Bills Allegedly Exceeded the Amount AMR was Authorized to Charge.
Residents describe a common bill for ambulance transportation to be more than $1,000 for a single ambulance trip, which is approximately sixty-six percent (66%) more than AMR is authorized to charge under its contract with the city.
The city began its contract with AMR in January 2011, after the city's previous ambulance service went out of business. The city’s fire chief said that under AMR’s contract, the company cannot charge more than thirty-five (35%) above the Medicare rate.
AMR is allegedly cooperating in the review, but the audit will take about a month to complete.
Ambulance Services Companies Are Targets for Medicare Audits.
Recently, ambulance service companies have become the target of Medicare audits and are frequently accused of billing Medicare for unnecessary services. Medicare and Medicaid audits can result in overpayment demands reaching into hundreds of thousands of dollars and assessment of fines. Ambulance services were included in the Department of Health and Human Services (DHHS) Office of the Inspector General (OIG) work plan for fiscal year 2012 as an area that would be subject to scrutiny. Zone Program Integrity Contractors (ZPICs) and Recovery Audit Contractors (RACs) are launching audits of ambulance service providers and emergency medical transportation companies.
Contact Health Law Attorneys Experienced in Handling Medicare Audits.
Medicare fraud is a serious crime and is vigorously investigated by the FBI and the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG). Don't wait until its too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.
The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, ambulance services companies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Siefer, Ted. “Independent audit begins on Manchester ambulance service billing.” Union Leader. (July 23, 2012). From: http://www.unionleader.com/article/20120724/NEWS06/707249979
Siefer, Ted. “City will conduct audit ambulance service over overbilling.” New Hampshire.com. (July 28, 2012). From: http://www.newhampshire.com/article/20120729/NEWS0603/707299953/1007
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
Tag words: ambulance services, Medicare fraud, Medicare audit, falsified data, falsified reports, Department of Justice, DOJ, FBI, investigation, emergency medical transportation, ambulance company, overbilling, health care fraud, conspiracy, false representation, Centers for Medicare & Medicaid Services, CMS, Department of Health and Human Services, DHHS, Office of the Inspector General (OIG), unnecessary services, Zone Program Integrity Contractor, ZPIC, Recovery Audit Contractor (RAC)