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Will EMS insurance fraud ruin it for the rest of us?

It’s alarmingly simple for someone with criminal intent to get into the medical transportation business, which could lead more regulations and less reimbursement

Back in 1989, a growing private ambulance company that provided 911 service to several communities in the metro Boston area suddenly went out of business, its owner convicted of Medicare fraud.

Decades later, the medical transportation industry struggles to escape its sordid past. Recent reports of Medicare fraud in cities like Chicago and Philadelphia are black marks in a profession that is inadequately reimbursed for its services.

As I pointed out in an earlier commentary, the issues surrounding EMS reimbursement are huge, and emblematic of a health care system that is structurally deficient and rewards bad behavior.

This article about ambulance services being held responsible for $5 billion in Medicare abuse points out some of the issues: low barrier to entry, little oversight, and an emphasis of transportation versus care. In another words, it’s alarmingly easy for someone with criminal intent to buy some ambulances, pay minimum wage to their employees, meet bare minimums of equipment, and get into the medical transportation business.

It’s tragic, since the public really doesn’t know the difference between a sneaky ambulance operator and a service that struggles to survive on what little they receive from insurance reimbursement. To them, we are these rolling boxes with flashing lights and a star of life emblazoned on the side.

That perception will be shared by the politicians and lawmakers, who I fear will end up painting all of the profession with the same “we don’t trust you” paintbrush. Whether this will translate into even more regulations and less reimbursement rates remains to be seen.

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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