On September 24, 2013, the US Department of Health and Human Services Office of the Inspector General’s (OIG) Office of Evaluation and Inspections (OEI) issued a report (OEI-09-12-00350) entitled “Utilization of Medicare Ambulance Transports, 2002-2011″.
The OIG has in the past focused on overutilization of ambulance transportation and identified these services as an area of concern. This recent report found that the overall number of ambulance transport claims during the time period in question increased by 69%, while the total number of beneficiaries during the time period increased by 7%. Further, the OIG also zeroed in on transports to or from independent dialysis facilities (dialysis-related transports) which it found had increased 269%.
This report represents yet another signal that the OIG is going to focus on eligibility for ambulance transportation and potential overutilization of these services. The OIG concluded that “increases in the utilization of ambulance transports are disproportionate in relation to increases in the population of Medicare fee-for-service beneficiaries.” The OIG is also very likely to focus on dialysis-related transports in the coming year, which among the OIG’s findings seem to represent the low-hanging fruit given the 269% increase the OIG identified. The OIG specifically commented in its conclusion that “[a]lthough dialysis facilities are a covered destination, transports to them do not usually meet coverage requirements under Medicare.” However, the OIG did not, in reaching its conclusions in this report, “determine whether the utilization changes described …were appropriate, that is, whether transports met Medicare coverage requirements.”
The increase in ambulance transports, generally and dialysis-related specifically, are a signal of enforcement priorities to come. Ambulance providers should ensure that internal compliance functions are robust and focusing on evaluating Medicare eligibility, particularly for dialysis-related transports.
You can find a copy of the OIG report here —> OEI-09-12-00350
For more information on the OIG Report, Medicare Program Integrity initiatives or related issues, please feel free to contact Ari Markenson or any member of our health care practice group for a further discussion.