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Types of Fraud and Abuse in NEMT Explained | Safrcare


Since the COVID-19 pandemic, fraudulent activities including abuse and scams have increased across multiple industries, and The Non-Emergency Medical Transportation (NEMT) industry has had its share of such incidents. Fraud and abuse are a concern for patients, providers and the ecosystem as they can span across multiple categories such as billing discrepancies (including unauthorized billing), false reporting of services, unnecessary tests or treatments, using unauthorized vehicles and more. These activities can lead to patients not receiving the timely and proper care they need.


Here is a look at some of the most prevalent types of fraud and abuse in the NEMT industry:


Billing for Services Not Rendered


When patients or insurance providers are billed for trips that never actually occurred; this can also include billing for an additional attendant (i.e., a beneficiary caretaker) when none was provided.


Unspecified Overbilling


Providers may engage in deceptive billing practices to receive excess payment, whereby they are misrepresenting actual trips and services.


Upcharging


Billing for an attendant when one was not necessary.

Billing for an ambulance when a less expensive form of transportation could have been used.

Billing for non ambulatory support services when the beneficiary was ambulatory.


Undocumented Trips and/or Forged Documents


Missing and forged supporting documentation of trips, including transportation provider trip logs, signed certificates of medical necessity, and signed transportation vouchers.


Billing for Excess Mileage


Billing for a 30-mile trip when a 15-mile trip was actually taken.


Nonmedical Use of NEMT Services


Billing for services when taking a beneficiary to pick up groceries or run other errands.


Billing Without a License and/or Using Unauthorized Providers


Providing services through unauthorized personnel.

In these cases, NEMT providers might be unlicensed, have bad driving histories, have failed drug tests, or have been convicted of felonies.


Double Billing for the Same Service


Submitting two claims for the same service by changing the service date on one of the claims.


Kickbacks


Providing free rides for nursing home providers to gain the business of the Medicaid beneficiaries who live there.

Paying beneficiaries to use a particular service.

Paying anyone who has influence over beneficiaries' use of services, including caseworkers, nursing home or hospital transportation coordinators, dialysis center employees, and rehabilitation center employees.


Ineligible or Deceased Beneficiary


Inappropriately providing rides to the family members of beneficiaries. Billing Medicaid for services for deceased beneficiaries.


Patient Abuse or Neglect


Physically or sexually abusing beneficiaries.

Leaving beneficiaries unattended or deserting them. Not picking up beneficiaries in a timely manner, resulting in missed appointments.


Although the non-emergency transportation industry is prone to abuse and fraud, there are still ways for patients to protect themselves. They should always be aware of the company they are working with and ensure that the personnel (including drivers) hold the proper credentials.

To prevent the spread of fraud, it is vital that people understand the various risks associated with non-emergency medical transportation and its ecosystem.