Medicare’s ambulance benefit is frequently misunderstood and SMPs commonly receive complaints about ambulance services that cover the entire range of suspected fraud, errors, and abuse. Sometimes providers bill beneficiaries directly rather than billing Medicare and the beneficiaries wonder why. Sometimes beneficiaries are seen being transported by ambulance when the trip doesn’t seem medically necessary and bystanders suspect fraud or abuse. At other times, Medicare denies coverage of an ambulance ride and beneficiaries wonder why their trip wasn’t covered.
Ambulance Fraud Schemes
- Falsification of documentation to provide the appearance of medical necessity, when medical necessity did not exist
- Billing for more miles than traveled for transport
- Billing nonemergency trips as emergency trips
- Billing the beneficiary instead of Medicare, if the provider participates in Medicare and the trip met Medicare’s coverage criteria
Report Suspected Fraud
To report suspected fraud, click here.