Medicare Compliance & Reimbursement

Prosecutors pursue new vehicles of Medicare fraud As a settlement in a district court case in the Eastern District of New York recently brought to light, even ambulance companies have joined the healthcare fraud brigade to make their quick millions. What Medicare Law Says Under Medicare "Part B" -- Supplementary Medical Insurance for the Aged and Disabled -- Medicare covers medically necessary ambulance services. Ambulance services are deemed medically necessary "if they are furnished to a beneficiary whose medical condition is such that other means of transportation are contraindicated." (42 CFR 410.40) Although "bed-confinement" is itself neither sufficient nor required as evidence of medical necessity, it is a "factor to be considered." A Medicare beneficiary is bed-confined if three requirements are met: "(i) the beneficiary is unable to get up from bed without assistance; (ii) the beneficiary is unable to ambulate; (iii) the beneficiary is unable to sit in a chair or wheelchair." [...]