Medicare Compliance & Reimbursement

The HHS Office of Inspector General has its eye on ambulance providers who submit Medicaid claims for the transport of hospitalized patients between facilities. In a joint review with the Illinois health department focusing on how the issue plays out in the Prairie State, auditors found that 13 ambulance providers improperly billed Medicaid for transports of hospitalized patients to a second hospital for outpatient services not available in the facility of origin. Most of the inappropriate claims involved transports for magnetic resonance imaging testing, the OIG notes in "Partnership Review of Medicaid Claims by Ambulance Providers for Transportation Services During an Inpatient Stay - Illinois Department of Public Aid, Springfield, Illinois" (A-05-02-00074). To see the report, go to http://oig.hhs.gov/oas/reports/region5/50200074.pdf. Lesson Learned: Medicaid rules may require an ambulance company to bill the hospital - not Medicaid - for transportation of hospitalized patients to a second facility for MRIs.