Thousands of Georgians require dialysis, but some patients admit they don’t require expensive, taxpayer-funded ambulance rides to get to their dialysis appointments.
According to FOX 5, non-emergency ambulance service is supposed to be restricted to people who cannot get to dialysis any other way without putting their health in danger. However three times a week, a Caring Hands ambulance pulled up to the homes of Georgians who say they didn’t need it. And those patients say Medicare is footing the bill.
This means, if the patient is on Medicare, it’s an average $500 taxpayer-funded payment to Caring Hands for every round trip.
FOX 5 asks how many really needed the ride?
“The ambulance service that carries a patient who can walk or who is not eligible for non-emergency ambulance knows exactly what they’re doing. And knows exactly how they get paid,” Rick Tibbetts, a former E-M-S owner and now consultant tells FOX 5.
During FOX 5’s investigation, crews repeatedly witnessed one Caring Hand’s patient climbing off the stretcher and walking up a flight of seven steps into her home after dialysis. Another patient was seen walking at least 20 feet to get to the stretcher waiting for her outside her home, and another patient was seen walking outside and climbing onto the stretcher.
According to FOX 5, several patients report they do have family and friends who can take them to dialysis, but taking the ambulance is a matter of convenience.
Tibbetts spent 35 years in the business, starting as a paramedic, ultimately owning his own ambulance service in Troup County and tells FOX 5, Medicare fraud within ambulance companies is out of control.
“There’s a lot of fraud through Medicare,” he warned as FOX 5 toured his facility. “Ambulances are just the tip of the iceberg, but there’s a lot of fraud I’m sure.”
FOX 5 reports there are cheaper ways to get people to dialysis who don’t have a ride. If they also qualify for Medicaid, the state and federal health program for the poor, patients can use a van service that takes them from door to door. They share the ride with other patients, but the one-way cost difference for taxpayers is striking. Tibbetts says it’s an 80 percent savings versus taking an ambulance.
The ambulance company FOX 5 watched — Caring Hands EMS — is run by Floyd Keels and lists his wife Shala as the Chief Financial Officer.
According to state corporation records, FOX 5 reports, the two are also listed as officers for a Mableton dialysis clinic. That’s where FOX 5 watched several Caring Hands ambulances bringing in and picking up patients.
FOX 5 reports no other ambulance providers during their investigation. Yet according to Medicare, there’s no rule preventing someone from operating both an ambulance service and a dialysis clinic.
When FOX 5 visited the Caring Hands office in Austell, Floyd Keels refused to answer any questions and asked reporters to leave the property.
Although it appears on the surface there is nothing illegal, it does suggest ethical considerations aren’t par for the course.
To combat this type of “ethical fraud,” FOX 5 reports Medicare is trying something different. In some states, ambulance services must now get prior authorization from Medicare before billing for non-emergency trips, and FOX 5 reports it’s working.
According to Medicare, FOX 5 reports, under the old rules in those states — when the government paid claims without asking for documentation first — non-emergency ambulance billing averaged nearly $18.9 million each month. In the first year of the new rules, that number dropped nearly 75 percent to $5.4 million monthly in the states that were part of the pilot program.
FOX 5 reports in South Carolina, considered by the government as one of the biggest ambulance dialysis abusers, during that first year 20 ambulance companies went out of business.
“Out of 200 ambulance services in SC, that means that 10 percent went out of business because they could not carry people that did not go to dialysis, need to go to dialysis in ambulances,” Tibbetts stressed.
“What does that tell you?”
“Tells me there’s a lot of fraud.”
Medicare wants to eventually make prior authorization the rule for all states, but at the moment, Georgia ambulance services operate under the old rules, taxpayers underwriting these red-light limo rides even some patients admit they don’t really need, according to FOX 5.
“They should be shocked,” Tibbetts warned for FOX 5. “Their tax money at work”
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