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Medical Ambulance Services, Inc., Claimed Unallowable Reimbursement for Medicare Part B Ambulance Services

Medical Ambulance Services, Inc. (MAS), located in San Juan, Puerto Rico, claimed Medicare Part B reimbursement for ambulance services that did not comply with Federal and Commonwealth of Puerto Rico requirements. Of the 100 claims in our random sample, 5 complied with Federal and Commonwealth requirements, but 95 did not. Of these, 40 contained more than 1 deficiency.

Specifically, we found that (1) for 72 claims, the signature of the beneficiary or their representative (acknowledging that the service was received) was not provided; (2) for 51 claims, the ambulance used in the service did not have a valid inspection or certification from the Commonwealth's Public Service Commission or Department of Health; and (3) for 18 claims, the service was provided during a period in which the ambulance used in the service was not covered under a liability insurance plan. In addition, 60 of the 100 services associated with our sample claims were provided by an emergency medical technician with a provisional license who was not accompanied by a permanently licensed paramedic-a potential health and safety risk.

We recommended that MAS refund $892,000 to the Federal Government. MAS discontinued operations in April 2016. Therefore, we did not make any procedural recommendations to MAS.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201