Lauren Fairlie
May 8, 2018
Billing & Administration
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What you need to know
For the past two years, the Department of Justice, through its local U.S. Attorney offices, along with the Department of Health and Human Services’ Office of Inspector General (OIG), has been actively investigating fire-based services for improperly billing Medicare for ALS ambulance transports when a BLS level service should have been billed. These investigations are ongoing across the country and involve all sizes and types of fire-based services. I am personally aware of multiple services under investigation that provide fewer than 100 Medicare transports annually. The issue at hand is that Medicare does not necessarily reimburse at an ALS level despite fire departments responding with ALS equipped and staffed ambulances. There are somewhat complex Medicare billing guidelines that must be followed to determine whether Medicare should be billed for an ALS or BLS service. However, it is exceedingly common for fire departments to simply bill Medicare at an ALS rate. By doing so, the government is claiming that these fire departments are violating the federal False Claims Act by submitting false claims to Medicare for reimbursement.
What you should do