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Home > Topics > Fraud
June 12, 2014
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EMS News in Focus
by Arthur Hsieh

EMS providers can't fix, but can combat Medicare fraud

EMS can’t control the health care finance system, but providers should remain vigilant against fraud in their own business

By Arthur Hsieh

In a previous column, I talked about a release of Medicare reimbursement information that raised eyebrows about how ambulance services are compensated in our health care system.

In another column, I also pointed out how gaming the system is alarmingly easy. A recent story alleging 37 New Jersey ambulance companies collected more than $46.5 million for non-emergency rides is a good example of how this is happening.

In some ways it’s emblematic of how our overall healthcare finance system runs. It’s a massive, extremely complex machine that is virtually impossible to understand and control.

Regulators put checks and balances into place to try to maintain fair and appropriate disbursement, but scammers of the system find a way to circumvent the rules or take advantage of them. These activities are always unethical, but not always unlawful. What results is a wasteful system that ironically fails to pay fully for legitimate services, and that nobody trusts.

As an EMS provider, why should you care?

Well, if you are a taxpayer, shenanigans like this affect your wallet. They also reduce the money that could have gone to your services, and gives EMS a bad reputation. Since the general public doesn’t differentiate between providers, we all get painted with the broad brush of criticism.

For those reasons, we need to remain vigilant against fraud within our own business.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
Comments
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Don Lyng Don Lyng Friday, June 13, 2014 5:02:00 AM Out of those 37 how many were Russian owned? Huge scam with those companies! Here in PA it is WIDELY KNOWN......and it takes forever to shut them down,and when they do a new one pops up in a week. Advantage and Penn Choice are the most recent in the Harrisburg area....Russian. Philly has put a moratorium on new Ambulance Companies due to this, so it is no surprise to see this many in Jersey. As for the EMT's who work for them.....they PAY decent....they have FULL TIME hours.....turnover is obnoxious because none of us want to be involved in the illegal activities once found out or if there is the remote possibility of shadiness but everyone has bills to pay and working 911 doesn't cut it here, not to mention getting hired here is ignorant because it is pretty much a 'Who you know' system and part time and $9 or &10 an hour. Many places here are now a combination of 911 and Transport because they HAVE to do both to survive and keep the doors open. Which is sad in so many ways but these are the times we live and if there is a will...there is a way for scumbags to take advantage to line their pockets.

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