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

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.

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