September 2009
OIG Says Medicare Paid Twice for Ambulance Transportation
The Department of Health & Human Services, Office of
Inspector General recently concluded that based upon a study
of certain 2006 claims, ambulance suppliers did not always
comply with consolidated billing requirements. The OIG
looked at 114 claims and found that more than 50 percent
were billed incorrectly to Medicare Part B. The erroneous
claims were associated with transporting Medicare
beneficiaries to received services that did not suspend or
end their SNF resident status and were not related to
dialysis. According to the OIG, the ambulance
transportation was subject to consolidated billing and
should not have been billed to Medicare Part B. Thus, the
OIG concluded that the Medicare program paid twice for the
ambulance transportation: once to the SNF under the Part A
prospective payment system and again to the ambulance
supplier under Part B.
As a result of the OIG’s findings CMS is expected to
instruct its carriers to review all FY06 Part B ambulance
claims during Part A SNF stays. Based upon the OIG’s
sample, the review is expected to uncover more than $12
million in Part B overpayments.
CMS is also expected to take steps to go beyond FY06 and to
implement procedures to prevent, detect, and recover similar
overpayments.
Information will also be provided to the Recovery Audit
Contractors for their consideration.
Based upon available information it appears that
overpayments will be recovered from ambulance transportation
providers. It is unclear if ambulance transportation
providers will seek recovery from SNFs.
In light of the OIG’s findings, SNFs should ensure that they
provide sufficient information to ambulance transportation
providers concerning whether the transportation is covered
under Part A or Part B.
Questions may be directed to James E. Traester, LLC, CPA at
203.932.2931.
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