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OIG Report on Utilization of Medicare Ambulance Transports

Sep 26, 2013

On September 24, 2013, the Office of the Inspector General (OIG) issued a report entitled Utilization of Medicare Ambulance Transports 2002 - 2011, OEI 09-12-00350. The report lists the increases in ambulance transports and suppliers paid by Medicare Part B fee-for-service from 2002-2011, comparing many different categories. The report takes a sharp look at the growth of Part B Medicare transports since 2002 and finds that payments for ambulance transports have grown at a faster rate than ALL Medicare Part B payments.

In the report, the OIG points the finger squarely at BLS nonemergency transports as the primary reason why there has been what the OIG calls a "growing and disproportionate" increase in ambulance transports since 2002. The OIG found that dialysis-related BLS nonemergency transports increased 269% from 2002 to 2011. It's no secret that the OIG has long believed that billing for dialysis-related transports is highly susceptible to fraud and abuse. But this Report goes as far as to state: "Although dialysis facilities are a covered destination, transports to them do not usually meet coverage requirements under Medicare."

Today's announcement is also a precursor to a forthcoming report from the OIG, where it will identify ambulance suppliers that exhibited "characteristics of questionable billing" in the first half of 2012 and where those suppliers are located. 

Listed below are some of the statistics cited in the report. All are for increases from 2002 to 2011:
• the number of ambulance transports paid by Part B increased 69%.
• the number of Medicare beneficiaries receiving ambulance transports increased 34%, while the number of beneficiaries increased only 7%.
• the number of ambulance suppliers increased 26%.
• the number of ambulance suppliers providing BLS non-emergency transports nearly doubled.
• the number of transports to/from dialysis increased 269%.
• the number of transports to/from hospitals increased 55%.
• outpatient transports for partial hospitalization services at community mental health centers increased 829%.
• the origin of transports from the scene of the acute event to a hospital increased 112%, accounting for 13% of all transports to a hospital.
• the number of transports from a residence to a hospital increased 51%, accounting for approximately half of all transports to a hospital.
• emergency transports to a hospital increased 65%.
• non-emergency transports to a hospital increased 14%
• ALS emergency transports to a hospital increased 69%.
• BLS emergency transports to a hospital increased 60%.
• 15 diagnosis codes, used for billing ambulance transports, increased 100% and were for 35% of all transports to a hospital.
• there were 40% more outpatient visits to non-hospital facilities vs. 27% for all fee for service beneficiaries.
• of those noted in the bullet above, there was an increase of 829% to partial hospitalization program services at mental health hospitals.
• utilization increases varied tremendously by state with Utah being the lowest (8%) and California the highest (289%). Other states with very high increases were VA, SC, GA and NJ.
• 10 states had increases of 100% or more.
• payments increased 130% compared to 74% in overall Part B payments.
• ESRD patients increased 24%, but ESRD patients transported by ambulance increased 85%.

The report includes many charts and a few graphs that you will want to see. The entire report can be downloaded at http://oig.hhs.gov/oei/reports/oei-09-12-00350.pdf