8 Big Findings From the OIG’s Utilization Report

September 25, 2013, the Department of Health and Human Services Office of Inspector General (OIG) released a Report, Utilization of Medicare Ambulance Transports, 2002-2011, that takes a critical look at the growth of Part B Medicare ambulance transports since 2002.  The Report finds that since 2002, Medicare Part B payments for ambulance transports have grown at a faster rate than all Medicare Part B payments.  The OIG states that this increase in payments was caused in part by inflation, the transition to the ambulance fee schedule, and beneficiary utilization. But it’s also clear that the OIG believes that fraud, abuse and improper billing is to blame, especially in the BLS nonemergency realm.   

For the study, the OIG reviewed Medicare Part B claims for ambulance transports from 2002 to 2011.  The OIG also reviewed enrollment data for all Medicare fee-for-service beneficiaries during that period.  In particular, the OIG found that from 2002 to 2011:

  1. Payments for Ambulance Services Went up Disproportionately.  Payments for ambulance transports increased 130%, compared to the 74% increase in overall Medicare Part B payments
  2. Transports Increased Significantly.  Medicare ambulance transports increased 69% (from 8.7 million to 14.8 million)
  3. More Beneficiaries are Receiving Ambulance Transports.  The number of beneficiaries who received ambulance transports increased 34%, although the total number of Medicare fee-for-service beneficiaries increased just 7%
  4. BLS Nonemergency Providers are Outpacing Others. The number of ambulance suppliers increased 26%, but the number of ambulance suppliers that primarily provided basic life support nonemergency transports nearly doubled and the number of suppliers that primarily provided BLS nonemergency transports increased 92% (in 2002 these suppliers represented 7% of all suppliers and in 2011 they represented 11%)
  5. Beneficiaries are Using Ambulance Services More Often.  On average, beneficiaries received more transports, from an average of 2.4 in 2002 to an average of 3.1 in 2011
  6. Mileage is Increasing.  Ambulance suppliers billed for greater average transport distances (from 7.8 to 9.4 miles) and transports that were more than 20 miles were billed 111% more often in 2011 than 2002
  7. The Number of BLS Nonemergency Has Increased Significantly.   The number of BLS nonemergency transports increased by 94%
  8. ALS Emergency is Growing at a Significant Rate.  The total number of ALS emergency transports increased 68%
The OIG is clearly concerned that ambulance transports continue to grow at a faster rate than all other Medicare Part B payments.  Yet the OIG also seems to dismiss the fact that more providers are billing today.  Moreover, the introduction of the ambulance fee schedule in 2002 had a huge impact on billing in the ambulance industry, which seems to be understated in this Report.  Although this Report does not contain any formal recommendations, it is clearly another justification for enforcement agencies to come after ambulance providers and it sets the stage for increased fraud and abuse activity in our industry.