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There’s nothing fishy about ambulance services atop Medicare payment list

The danger of raw data is that it has to be interpreted and analyzed beyond the superficial first layer before it even begins to make sense

It shouldn’t come as a surprise that ambulance services are at the top of the Medicare national payment list released for the first time this week.

The EMS population is disproportionately represented by economically disadvantaged patients, and those with little or no health care insurance who rely on government assistance to pay for a minimum level of health care.

In this list, three of the 10 transportation agencies are county 911 providers, and it’s possible that at least a few of the remaining services are contracted providers.

If there is an implication that something fishy – or flat-out fraudulent – is going on with the medical transportation industry, you really have to look very closely at the numbers to understand exactly what they mean.

It’s true we’ve seen some spectacular fraud schemes over the years. But the rare instances are far outweighed by agencies that receive inadequate reimbursement for the cost of providing service.

The financial losses incurred in the treatment and transport of patients are offset by higher premiums and payments for those with health insurance or the ability to pay. EMS and medical transportation has played this cat-and-mouse money game for decades. It’s not right, and it’s not wrong - it’s just how it has always been.

Lawmakers who might inadvertently assume less-than-honest practices should take the time to really understand the flow of reimbursement money through EMS and emergency departments. Most of us will confirm we’re not getting rich off of these payments.

I have no doubt that stories of this nature will reappear in other states over the next few days and weeks. The danger of raw data is that it has to be interpreted and analyzed beyond the superficial first layer before it begins to make sense.

We’ll see whether that will happen.

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor 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 writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.

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