Ambulance Provider Settles CMP Case for $1.23M Over SNF Billing

SeniorCare Emergency Medical Services Inc., in the Bronx, New York, agreed to pay $1.23 million in a civil monetary penalty settlement over ambulance transports that were billed to Medicare when they allegedly should have been charged to skilled nursing facilities (SNFs). This is a risk area for ambulance companies because Medicare has specific rules on when they should bill Part B for ambulance transports to and from SNFs and when they should bill the SNFs directly, according to an attorney.

Compliance requires “the correct application of some idiosyncratic rules that tend to trip up ambulance companies,” said attorney Doug Wolfberg, with Page, Wolfberg & Wirth in Mechanicsburg, Pennsylvania.

According to the settlement, OIG alleged that SeniorCare billed Medicare Part B for services that were fraudulent. Between Jan. 2, 2014, and Dec. 29, 2018, the ambulance provider submitted claims for ambulance transports to and from SNFs when the transports were already covered by Medicare Part A consolidated payments for the SNFs. SeniorCare didn’t admit liability in the settlement, and its attorney didn’t respond to a request for comment.

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