Fox 26 News Report: Medicare Fraud Cases Holding Up Ambulances

Fox 26 interviewed Arrington Strickland, the owner of United EMS in Houston, a couple of weeks ago.  They played the interview on Monday, the 14th, and highlighted a problem in the Houston area – fraud related to ambulance transports for dialysis patients.

As Mr. Strickland noted, there is quite a bit of fraudulent activity going on in the Houston area, but they are trumpeting this like it is something new.  It is not – this type of fraudulent activity has been going on for at least the last 8 years that I am aware because it was happening when I was involved in the private ambulance business.  I have had discussions with FBI and HHS/CMS investigators and with DOJ personnel, all indicating that they have known there was a problem since at least 2003 (and before!).  But now they are putting companies on 100% prepayment review and turning the ZPIC’s (Zone Program Integrity Contractors) loose on ambulance companies.

The report as posted on the Fox website is after the jump:

RANDY WALLACE
Investigative Reporter

HOUSTON – FOX 26 was the first to report on massive Medicare fraud involving wheelchairs. Some unscrupulous medical supply companies were billing Medicare for wheelchairs that were not needed or in some cases never delivered to elderly patients.

The newest fraud involving your Medicare tax dollars? Private ambulance companies are billing millions to Medicare to take patients to dialysis treatment when those patients could easily make the trip in a car.

Chris Mozingo is not one of those dialysis patients taking Medicare for a ride. The only way he can make it to dialysis treatments is in the back of an ambulance.

“I know there are people that would literally die without this service,” Mozingo said.

“Believe me, I didn’t open this business to commit fraud,” said Arrington Strickland, owner of United EMS.

Strickland has no sympathy for ambulance companies who defraud Medicare and wants them to be held accountable. But the multi-million dollar fraud committed by other ambulance company owners has Strickland not only fearing for his business but for his patients lives.

“They are looking for ways not to pay and that’s the consistent issue with Medicare,” Strickland said.

Here’s how it works: Medicare will pay ambulance services to take nursing home patients to dialysis with no questions asked. But when the patient lives at a private home, the ambulance service must prove there’s no other way for the patient to get to dialysis except by ambulance.

“They’ve decided to deny 90 percent of the transports we do on a daily basis” Strickland said.

While Medicare is supposed to pay within 21 days, Strickland said in some cases he’s waited almost a year for payment.

A spokesman for Medicare told FOX 26 Investigates there is a delay in processing these types of ambulance transports. Non-emergency ambulance transports in Texas are the number one problem now being targeted for possible fraud and because of heightened scrutiny; payments to providers can take much longer than normal.

“I opened this business for the purpose of taking care of people,” Strickland said. “Now I’m subject to letting people down because I can’t take care of em.”

9 Responses to Fox 26 News Report: Medicare Fraud Cases Holding Up Ambulances
  1. Arrington Strickland
    December 30, 2010 | 9:26 pm

    Thank for posting the recent story, I felt the need to bring the story to the news, because there are companies that provide a needed service. Although I greatly appreciate having the opportunity. I really want to emphasize the fact that there has to be a method of enforcement that can be utilized, that legitimate businesses can operate without the delay of payment that can cause ruin. The 100% prepayment review is a step that I’m sure has a place in enforcement. It’s just imperative that this review has determining factors… Is the company practicing in good faith? Are the patients truly in need of the service..etc? These determinations should not be based soley on an individual reviewing claims. Actual contact with patients that have claims that are thought to be questionable. These are just my suggestions. I’m sure there are people with ideas on how to improve the system, I’m open for suggestion that will improve the industry. Over all

  2. Marc M. Meyer
    December 30, 2010 | 9:39 pm
    Avatar of Marc M. Meyer

    There are many issues related to the ambulance transport benefit in the Houston area – some of which you raised in the piece. The prepayment review of the dialysis transports after 12 transports will destroy many legitimate businesses in the name of rooting out fraud. I truly believe that CMS is being penny wise and pound foolish in this manner and many of those who will now not be transported to dialysis by ambulance will not go, thus causing significant problems that will require hospitalization, including ICU admissions, and increased costs overall to the medicare system. But CMS is looking at this issue through a one dimensional filter and not taking into account external issues when they issue the guidance on these regulations.

    Marc

  3. Loretta
    January 24, 2011 | 9:20 pm

    I own an ambulance service also. I too am being forced to probably close because Medicare has not
    Paid me since july. I have employees 3 extra people to ensure we take only patients who qualify. Those of us that are doing it right are the ones closing. Those that are committing fraud will continue on because they have extra money from taking patients who did not qualify. The real losers are the patients. I had one patient say that she would just go ahead and stop her treatment and die. I could not let her do that. I have continued to take her even though I have not been paid for her transports since July. I have been a registered nurse for 27 years and got into healthcare because I love taking care of people. The government is rationing care already. This is only the beginning. The patient is being punished for trying to stay at their residence as long as they can. Medicare admin use your brain, it is going to cost you more in the long run. We had a patient That Medicare said should go by wheelchair and she fell out of chair in route. This resulted in a five day hospital stay, possible lawsuit, and not to mention the problems it caused the patient. You really saved on that one Medicare. The whole situation is a mess.

  4. Marc M. Meyer
    January 25, 2011 | 7:06 am
    Avatar of Marc M. Meyer

    You need to speak to an attorney as soon as possible. If Medicare has not been paying you since July, you have a serious problem and need to solve the problem. I don’t know where you are, but feel free to contact me and I will put you in touch either with someone in your area or I will work with you if you would like, but you need to have some additional counsel on this matter, ASAP.

    Marc

  5. Linda
    October 3, 2011 | 1:50 pm

    We are going thru the same thing. Our Medicare money stopped in July and they are still sending letters in September and no one can give me any idea when this will end. We have gone thru all the classes and we have been told by our billing company that our documentation is the best she’s ever seen. Out of all of the transports they have investigated only about six have been returned and these are all being appealed because these are the same people with the same problems with very similar documentation. If you spent 5 minutes with our patients it would be obvious to anyone why they need an ambulance. These are people who worked all their lives paying into the system just like all of us and now they are being treated like they don’t deserve to live anymore. I realize that there was and may still be a lot of fraud in Houston. But I believe most of those companies have already moved on to greener pastures or have left the country. Now the RAC is targeting legitimate companies who are just trying to provide a service to people, provide jobs, pay taxes and participate in a failing economy. I can promise you none of our getting rich. Those of you who want to fall into the “Medicare Fraud” Witch Hunt that has taken now taken over the industry, I hope there will be a legitimate ambulance company still in business when you get old or disabled and need to be transported. Two of the patients that they have been auditing since July have already died. We are still transporting our patients even though we are not getting paid because we have a relationship with these people and a commitment to make sure they get what they need. We have had to shut down to operating only three days a week, we have had to let a lot of people go, and we are having to take money out our own personal savings and paychecks from other jobs to keep the company in business. Oh yes, us fraudsters are really getting rich off America’s back. We can’t do anything to fight back because we have been told by many if you say anything or try to do anything to question the inquisition there will be retaliation. For those of you who are going thru this I am so sorry. I know there are people out there committing fraud but there are also a lot of honest business owners out there that are just trying to make a living.

  6. Marc M. Meyer
    October 4, 2011 | 6:56 am
    Avatar of Marc M. Meyer

    Linda,
    I agree whole-heartedly with your comments. Unfortunately, very few companies in this business are well capitalized and can withstand the loss of Medicare payments for any sustained period of time. I get occasional inquiries regarding this issue, but rarely does anyone have the time and money to truly fight this issue. The billing companies need to shoulder part of the blame, because they are not well suited to handle the Medicare appeals process, in my opinion, and often seem to either just throw their hands up in the air or just plainly drop the ball. The timelines for Medicare appeals are not long and by the time I am called, many businesses are outside their appeal windows or just flat don’t have the information necessary to mount an appeal – much less do they have the money to fight the process, especially when it can drag on for over a year and still end up without payment being made by Medicare.
    Marc

  7. Hal
    August 1, 2012 | 2:23 pm

    Our company is in the same situation. We have not been paid for our dialysis patients since July 2011. Trailblazer states that only 10% of dialysis patient should require a stretcher. There are over 350 dialysis patients in my city and only about 15 are taken by ambulance between 3 ambulance servicies.
    3 of our patients have died within this period. One patient was so distressed after we extinguished our appeals and put him with a wheelchair service that he took himself off of dialysis and died. He fell out of the wheelchair the first week with this service…they had to call the fire department to help lift him back into the chair. His legs were amputated at proximal femurs and he weighed 267 lb’s . He had a chest catheter and did not need to be lifted by his arms. I think Trailblazer wants them to die.

  8. Sheila
    September 13, 2012 | 7:10 am

    MEDICARE CAN PAY CERTAIN AMBULANCE SERVICES, BUT THEY SURE WONT PAY US. ?????? I believe they put us through
    most hell.??????

    Patient care has no color.
    Love, care and compassion is what saves a life, not color.

    “Color only blinds the eyes and diminish ones thoughts”