CMS Proposes New Enrollment Rules–Ambulance Providers Targeted

The Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule on April 29, 2013 that changes current Medicare enrollment processes. Specifically the Proposed Rule addresses the following: 1) Limitations on Ambulance “Backbilling”: Currently, ambulance providers who enroll in the Medicare Program are able to “backbill” Medicare for services furnished prior to enrolling if those […]


Florida Agency for Health Care Administration Drafting New Version of Ambulance Provider Manual

Florida Agency for Health Care Administration (AHCA) will be holding a public hearing regarding the proposed changes to the Medicaid Ambulance Transportation Provider Manual. These changes will include: (1) Removal of Medical Condition Code List and the insertion of the “medical necessity” definition found in Florida Administrative Rules; (2) Addition of possibly more stringent prior-authorization […]

PA Ambulance Provider Owners Plead Guilty to Health Care Fraud

See Link: The owners operated an ambulance company (MedEx Ambulance) that transported patients who were able to walk and could travel safely by means other than ambulance and who, therefore, were not eligible for ambulance transportation under Medicare requirements. The ambulance company’s owners and representatives falsified reports to make it appear that the patients needed to […]

Hospital FCA Settlement for Ambulance Services

Wayne Medical Center in Waynesboro, Tenn., agreed to pay $883,451 to settle allegations that it submitted false claims for ambulance services that were not medically necessary or coded correctly (AIS, Report on Medicare Compliance, Jan. 21, 2003). The settlement stemmed from the hospital’s self-audit of Part B billing for ambulance, which triggered a self-disclosure to the […]

DHHS OIG Publishes Review of ALJ Appeal Process

Dept. of Health and Human Service Office of Inspector General (“OIG”) published a review of the Administrative Law Judge (“ALJ”) Medicare appeal process. The report makes many recommendations for the improvement the process. One of the recommendations unfortunately is the institution of a statutory filing fee for all ALJ appeals. They did not specify how […]

CMS Finalizes Proposed Rules

NO END IN SIGHT… The Centers for Medicare and Medicaid Services (“CMS”) has finalized its proposed revisions regulations regarding: (1) Termination of Non-Random Prepayment Complex Medical Review; and (2) Ambulance Coverage–Physician Certification Statement. (1) Termination of Non-Random Prepayment Complex Medical Review: Non-random prepayment complex medical review (“Prepayment Review”) is a process by which these Medicare […]

Houston Ambulance Provider Pleads Guilty

Houston-based ambulance company pleaded guilty to charges he submitted approximately $1,734,550 in fraudulent claims to Medicare. The ambulance provider was transporting patients that did not meet the requirements for ambulance transport un der Medicare regulations, falsifying ambulance run reports, and submitting medically unnecessary claims to Medicare. This is yet another example of the increased scrutiny […]

OIG Evaluates Corporate Integrity Agreements

The Office of Inspector General (OIG) at the Department of Health and Human Services (HHS) held a round table meeting with different providers (including ambulance providers). These providers discussed their experiences operating under a Co rporate Integrity Agreement (CIA). The purpose of this meeting was to discuss the providers’ suggestions for improvements to the future […]

OIG Targeting Repetitive Ambulance Transports In 2013

OIG put out its Work Plan for 2013, which has remained mostly unchanged from the 2012 WP. It contains provisions indicating the ongoing targeting of ambulance providers, specifically with respect to medical necessity/level of care and repetitive transports. OIG will be targeting providers that are servicing patients that receive high cumulative Medicare Part B payments. […]