I’m Shocked, Shocked: Allegations of Medicare Fraud in New Jersey

Ambulance at Emergency EntranceDozens of New Jersey ambulance companies — most of them headquartered within 15 miles of Paterson — billed Medicare for unusually large numbers of non-emergency ambulance rides in 2012, a ProPublica analysis of recently released Medicare payment data found.

Some 37 operators claimed an average of 50 trips or more per patient, collecting more than $46.5 million from Medicare that year. By comparison, in 33 other states, not a single ambulance company billed Medicare for that many rides per patient, the analysis showed.

Prosecutors had video showing some patients walking to and from ambulances, or even being driven to dialysis in personal vehicles instead of the ambulances for which Medicare was billed, Assistant U.S. Attorney Beth Leahy said.

“It’s direct evidence that these patients are ambulatory,” she said, “that they don’t need to be transported by ambulance, yet the companies are submitting claims to Medicare stating that the transport by ambulance is medically necessary for their wellbeing.”

(Charles Ornstein, ProPublica)

Comments (9)

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  1. Devon Herrick says:

    The various allegations of improper (or improbable) Medicare billing makes me wonder where the OIG was during all of this? Of course, I know where: likely sitting back in their offices. Anytime OIG tries to put a stop to a Medicare vendor looting the Treasury, the offending firm runs to their local Congressman and complains. What I cannot figure out is why the fraud is so concentrated? Miami/Dade has some of the most egregious cases of Medicare fraud in the country. Brooklyn has a concentration off physical therapy fraudsters. New Jersey has ambulance companies that engage in questionable billing and fraud. Do these guys talk to each other and compare notes?

  2. Big truck joe says:

    OIG and the various other govt. Medicare supervisory agencies are too busy harassing large publicly held hospitals nursing homes and DME companies over paperwork issues and medical necessity calls. In other words, grey area of “fraud and abuse”. That’s where the money is and it doesn’t give them much time to go after the actual criminals.

  3. Steve says:

    Medicare is not going to be anywhere near as capable of reducing fraud as a private insurance company that actually cares about its bottom line. In short, this is what you get anytime you have a government program run by people using other people’s money…no incentives to curtail waste, fraud, and abuse.

    • Buddy says:

      When no one but the government is footing the bill, everyone is going to try to cheat their reimbursement numbers. Health care should be between and doctor and a patient and no third parties.

  4. Brad says:

    I feel as though all aspects of the Affordable Care Act/Obamacare, especially the expansion of Medicaid, will fall victim to the same problems that beset the VA health system. It will inevitably fail and implode.

    • Matthew says:

      Anything government run will fail and implode. They debt just keeps getting higher. Just wait for the bottom to fall out.

  5. James M. says:

    Medicare has been incorrectly billed again? Oh the humanity! As long as there are incentive to cheat on reimbursements, there will always be fraud in Medicare.