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.

About the author

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 Art.Hsieh@ems1.com and connect with him on Facebook or Twitter.

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