Unrestricted National Medicare Fraud Alert (UMFA 9604).

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Unrestricted National Medicare Fraud Alert (UMFA 9604)

Unrestricted National Medicare Fraud Alert (UMFA 9604, issued June 14, 1996):

Billing for Medically Unnecessary and Non-Covered Ambulance Services

Companies billed non-emergency transport for hospital discharges and

non-emergency round trip transport for beneficiaries to hospitals for ongoing

outpatient services such as chemotherapy and ESRD treatments. Many of the trips

did not meet medical necessity criteria and other modes of transport would have

been safe and appropriate. The following non-emergency codes could be at issue;

Ambulance service, basic life support (BLS) A0300, A0320, A0340, and A0360;

Ambulance service, advanced life support (ALS), non-emergency transport, no

specialized ALS services rendered A0304, A0324, A0344, and A0364; and Ambulance

service, ALS. non-emergency transport, specialized ALS services rendered -

A0306, A0326, A0346, and A0366. Additional charges for mileage and waiting time

could be involved; A0380, A0390, and A0420.

The ambulance companies billed for transportation of dialysis patients who were

ambulatory and/or did not require ambulance transport. The patients did require

thrice weekly dialysis treatments as certified by a physician. The ambulance

company transported patients from nursing home facilities and used modifiers for

" bedridden " , " transported by stretcher " and/or " hospital lacks facility. " The

nursing facility did not arrange for other means of transportation and relied on

the ambulance companies to transport the patients.

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Last Updated October 29, 1999