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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.

Filed under: Centers for Medicare and Medicaid Services