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. 

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