Ambulance service fraud happens when providers submit false or misleading claims for reimbursement. Fraudulent ambulance claims cost Medicare, Medicaid, and private insurers millions of dollars each year, increasing overall healthcare costs.
Billing for unnecessary services
One common form of ambulance fraud is charging for services that are not medically necessary. Some providers bill for emergency ambulance transport when the patient does not require urgent care. Others transport patients by ambulance when a more affordable option, like a wheelchair van or non-emergency transport, would have been sufficient. These practices waste resources and drive up costs for patients and insurers.
Upcoding and false claims
Upcoding is another common scheme. This occurs when a provider bills for a higher level of service than was actually provided. For example, an ambulance company may claim a patient needed advanced life support when only basic medical care was given. Fraudulent claims can also include billing for treatments that never happened, such as oxygen administration or heart monitoring. These false charges allow companies to collect more money than they should.
Kickbacks and illegal referrals
Some ambulance providers participate in illegal kickback schemes. They offer payments to hospitals, nursing homes, or other healthcare providers in exchange for patient referrals. These unethical agreements lead to unnecessary ambulance transports. This can inflate costs and divert funds from legitimate healthcare needs.
The impact of ambulance fraud
Ambulance fraud increases healthcare expenses, drains taxpayer-funded programs, and reduces resources for those who genuinely need emergency transportation. Strict regulations and oversight help detect and prevent fraud, ensuring that ambulance services are used appropriately.