Enough is enough! Once again, a “new” report on ambulance fraud from Medicare’s Office of the Inspector General (OIG) has triggered yet another media feeding frenzy directed toward Texas’ ambulance providers generally and Houston-based providers specifically.
The “new” report was released on September 29th and is entitled, “Inappropriate Payments and Questionable Billing for Medicare Part B Ambulance Transports.” Not surprisingly, the entire ambulance industry is again being slathered with a fresh new coat of fraud-colored paint.
Break out the pitchforks and torches – those ambulance crooks are at it again!
But, all is not as it might first appear. This “new” report is based on Medicare data that is over three-years old. And that is the crucial point of this op-ed. The data used in the OIG’s report came from data extracted from the first six-months of 2012. The OIG failed to mention that sweeping anti-fraud statutory and regulatory changes were implemented in Texas in 2013 as a result of the 83rd legislative session.
Spearheaded by the bold efforts of Senator Jane Nelson, (now) Senator Lois Kolkhorst and Representative Richard Raymond, the new anti-fraud bill (Senate Bill 8) was signed into law in June of 2013, which is a year after the data used in the OIG’s report. Its impact on the reduction of ambulance fraud, waste and abuse in Texas has been impressive to say the least. What used to be a destination spot and safe haven for criminal ambulance operators has now become “white hot” with regulatory oversight from the Department of State Health Services, new investigative and enforcement tools for Medicaid and barriers to entry into the ambulance marketplace that are making it impossible for them to come to Texas, take root and survive.
The 2013 legislative session was significant because all involved were committed to solving the ambulance fraud problem, which had eaten hollow the credibility of Texas’ ambulance providers and robbed taxpayers of many millions of dollars. Lawmakers, regulators and legitimate ambulance providers all pulled together and toiled for many long hours to finally put an end to the lingering menace of ambulance fraud in Texas, none of which is mentioned in this “new” OIG report.
The changes that resulted from Senate Bill 8 of 2013, and which were not recognized in this “new” OIG report included: a one-year statewide moratorium on the issuance of EMS provider licenses; financial barriers to entry in the form of a $100,000 letter of credit; a $50,000 surety bond requirement to protect the Texas Medicaid program against provider overpayments; training requirements and experience criteria for Administrators of Record; county or municipal consent requirements to start a new ambulance service, along with a 2-year geographical migration restriction; a proof of ownership requirement on all EMS-related capital equipment; restrictions on ambulance provider business occupancy; criminal background checks on ambulance administrators; new criteria for the suspension, revocation and denial of provider licenses; and, enhanced investigation and enforcement capabilities for the Health and Human Services Commission’s OIG.
So, have these new anti-fraud reforms been effective? You bet they have! Prior to the 2013 law, there were 1,227 ambulance provider organizations in Texas, while today there are just 832. In the Greater Houston area alone, the number of ambulance providers has decreased from a previous high of 409 to 155. Since the end of the statewide moratorium on the issuance of provider licenses on September 1, 2014, the Department of State Health Services has only granted two licenses to private-sector providers and twelve to government-based providers. It’s working.
To the citizens of Texas, it’s important to understand that the health care provider category of “medical transportation providers” represents only 2.2 percent of all federal criminal and civil fraud investigations according to the Government Accountability Office (GAO.) The vast majority of health care fraud is committed by other health care providers who rarely attract the kind of relentless media attention that is directed toward ambulance providers.
To the media, who have historically censured all Texas ambulance providers for the sins of the few, please appreciate that many people have worked very hard to remedy the ambulance fraud problem in Texas – and those efforts are proving to be stunningly successful. There’s no longer an excuse for this kind of rush to judgment – at least not in Texas.