Ambulance trips for dialysis treatment rose 269 percent for Medicare recipients between 2002 and 2011, while the number of covered trips overall rose 69 percent, the Office of Inspector General found in a new report.
Although dialysis clinics are approved as a destination for seniors with Medicare fee-for-service coverage, “transports to them do not usually meet coverage requirements under Medicare,” OIG found. Beneficiaries who need the treatment, which filters impurities that accumulate in the blood because the kidneys are not working properly, typically need the care three times a week, so patients usually receive six transports each per week.
Medicare’s ambulance benefit is “vulnerable to abuse,” according to past OIG reports. A 1996 report found that two-thirds of ambulance transports did not result in expected hospital or nursing home admissions or emergency rom care that was medically necessary. Another report found that 25 percent of ambulance transports in 2002 did not meet Medicare program requirements, resulting in an estimated $402 million in improper payments.
The OIG also found that 27 percent of transports to and from independent dialysis facilities in 2002 did not meet government reimbursement requirements.
Medicare doesn’t limit the number of ambulance transports for beneficiaries, which is warranted only when using another means of transportation would “endanger the beneficiary’s health.” In recent years, the Government Accounting Office and Medicare Payment Advisory Commission have probed the growth of ambulance utilization.
OIG’s report did not include recommendations as the agency continues to analyze Medicare claims. The analysis will identify ambulance companies with questionable billing in the first half of 2012.