Medicare Made Improper and Potentially Improper Payments for Emergency Ambulance Transports to Destinations Other Than Hospitals or Skilled Nursing Facilities

Medicare payments to providers for emergency ambulance transports did not comply or potentially did not comply with Federal requirements. Specifically, Medicare made improper and potentially improper payments totaling $1.9 million: (1) improper payments of $975,154 for transports to destinations that were not covered by Medicare for either emergency or nonemergency ambulance transports, including the identified ground mileage associated with the transports, and (2) potentially improper payments of $928,092 for transports that may not have met Medicare coverage requirements or might have been paid by Medicare as nonemergency ambulance transports. During our audit period (calendar years 2014 through 2016), the Centers for Medicare & Medicaid Services (CMS) did not require the Medicare contractors to implement nation-wide prepayment edits that would either deny payments or mandate prepayment review for emergency ambulance transports to destinations other than hospitals or skilled nursing facilities.