Ambulance companies that transport patients to life saving treatments like dialysis and chemotherapy are up against a federal pilot program, which they say is getting in the way of patient care.
Our Investigation Team looked into those claims, and News 2 investigative reporter Rebecca Collett found an attempt to crack down on Medicare fraud could hurt the most in need of medical attention.
The pilot program was launched in response to the use of non-emergency ambulance transports skyrocketing from 2002 until 2011, but the program rolled out in South Carolina over the last year has some living with debilitating illness unable to get to their life saving treatments.
“They give me a service that is absolutely necessary,” Dick Linder, Dialysis patient, explained of his regular rides in an ambulance.
The rides are covered by Medicare for those who needs medical attention during a ride to treatment.
The CEO of Medtrust, Josh watts, says the federal pilot program that requires prior authorization for the non-emergency rides will cost the sick their lives, and the mounds of paperwork is putting other ambulance companies out of business
“Most of us got into the business to help people, and what that means is we will over extend without the ability to bill,” he explained.
The program was rolled out in 2015 to reduce costs to Medicare in South Carolina, New Jersey, and Pennsylvania. In the New Year, the program rolls out in six more areas.
According to a study released by the Department of Health and Human Services, the use of non- emergency ambulance rides skyrocketed between 2002 and 2011. In major increases in hospital rides which rose 55%, followed by trips to dialysis treatments, which jumped 269%, and transports for mental health services, up 829% over that time period.
Medicare processing company, Palmetto GBA, declined a taped interview, but in a statement wrote:
“Palmetto GBA is consistent in the application of CMS guidelines. Our oversight ensures that taxpayer dollars are spent appropriately for the services it covers. It should be noted that the long-standing Medicare guidelines for ambulance transport have not changed at all. Prior authorization did not create new clinical documentation requirements. Instead, it requires the same information necessary to support Medicare payment—just earlier in the process. It actually helps the patient to have the documentation submitted up front, which ensures that if there are questions, they get addressed early on. Finally, Palmetto GBA offers a robust education program and maintains an open door policy so that questions are welcomed and providers receive the information they need.”
Patients and drivers question at what cost to sickest people. Prior authorization is required every 60 days and takes up to 20 business days to be approved.
“Taking a patient that we have gotten through the gauntlet and they’ve been approved, 60 days later, we have to do that process again,” Watts said. “For a patient that has no legs, has no arms, and is blind, they aren’t getting better.”
Palmetto GBA could not release bench marks for savings through the program. They also could not release data on how much has been saved or how Medicare is monitoring access to healthcare.