The Centers for Medicare and Medicaid Services (CMS) is continuing a four-month crackdown on Medicare fraud in New Jersey. CMS has accused ambulance companies of fraudulently billing Medicare for transporting patients to non-emergency dialysis, chemotherapy and wound care. CMS found that these ambulance trips in New Jersey were twice the national average (from 2002 to 2011), and that the number of trips per patient was up approximately 60%. At least 11 ambulance companies report closing in recent months.
The ambulance companies in New Jersey are now required to obtain pre-authorization from Medicare to transport a given patient, and many of these applications for pre-authorization are denied. CMS says it has no plans to expand the crackdown beyond New Jersey, Pennsylvania and South Carolina.
While preventing Medicare fraud is important, so is ensuring that dialysis patients have transportation to their facilities. Balancing these two goals will help ensure Medicare’s sustainability, which in turn will improve patient outcomes.