Review of Medicare Claims for Air Ambulance Services Paid to Native American Air Ambulance

EXECUTIVE SUMMARY:

Our objective was to determine whether Native Air claimed air ambulance services for calendar year 2002 pursuant to Medicare billing requirements.  Of our random sample of 100 claims, 15 claims were improper.  Of the 15 claims, 1 claim was for a medically inappropriate service, and 14 claims were for transporting patients beyond the nearest hospital with appropriate facilities. As a result, $10,589 of the $330,713 reviewed was unallowable.  We estimated that at least $62,408 of the $3,968,759 paid to Native Air for air ambulance claims was unallowable for Medicare reimbursement.  We recommended that Native Air:  (1) refund to the Medicare program $62,408 in overpayments, (2) strengthen policies and procedures to ensure that only medically appropriate air transport services are billed to Medicare, and (3) strengthen policies and procedures to ensure that air transport services are billed for the mileage to the nearest hospital with appropriate facilities and that documentation in the medical records supports the reason for transporting patients beyond the nearest hospital with appropriate facilities.  In written comments, Native Air disagreed with our findings and procedural recommendations and did not comment on our recommendation for a refund.