OIG: Medicare overpaid millions for nonemergency ambulance transport

Inappropriate use of nonemergency ambulance transport cost Medicare $8.7 million in overpayments, according to a recent Office of Inspector General (OIG) report.

The OIG reviewed Medicare nonemergency ambulance transport claims from 2014 through 2016. Medicare will only cover ambulance transport to specific covered locations such as hospitals or skilled nursing facilities (SNF). However, the OIG discovered that during the review period Medicare paid $5.5 million for nonemergency ambulance transport to noncovered locations including transport to diagnostic or therapeutic sites, excluding those located in a hospital or physician office, and that did not originate from a SNF. In addition, Medicare paid $3.2 million for ground mileage for transport to noncovered locations.

Although a portion of the total overpayment falls outside of the four-year claim reopening period, the OIG recommends that Medicare contractors recover the amount that is within the claim reopening period. For those claims that cannot be reopened, Medicare contractors should contact the providers and notify them of the overpayment so the providers can investigate, report, and return any similar overpayments. In addition, the OIG recommends that Medicare contractors begin auditing nonemergency ambulance transport claims and implement nationwide prepayment edits to curb future overpayments.