Original Medicare covers ground and air ambulance services when they are medically necessary. That means a wheelchair van or car could endanger the patient and would be an unsafe means of transport. The ambulance and crew must meet certain standards and provide transportation to the nearest appropriate facility such as a skilled nursing facility or hospital. A bill from an ambulance ride can add stress to anyone’s emergency situation, especially if the charges are incorrect. In an emergency, the last thing anyone wants to think about is the bill. It is important to know what your coverage does for you and how it works.

The NYS Senior Medicare Patrol (SMP) receives calls from individuals asking what to do in challenging situations like this. The SMP program educates Medicare beneficiaries on how to protect themselves from fraud and abuse and is the go-to when people suspect they’ve been billed incorrectly.

“Sometimes a provider will bill beneficiaries directly instead of billing Medicare, even though the provider participates in Medicare and the trip met coverage criteria,” said Tiffany Erhard, state Senior Medicare Patrol Outreach Counselor. “Sometimes the provider does submit the bill, but Medicare denies coverage and the beneficiary doesn’t understand why.”

Some different types of fraud schemes include providers billing for more miles than the beneficiary was transported or billing nonemergency trips as emergency transport.

To stop ambulance fraud, the NYS SMP recommends that beneficiaries:

¯ Review their Medicare Summary Notices (MSNs) and/or Explanations of Benefits (EOBs) and ensure the following:

¯ The services listed match what they actually received.

¯ The mileage billed isn’t more than the distance traveled.

¯ They weren’t billed for emergency transport if there wasn’t an emergency.

If you think you may have been a victim of fraud, call the NYS SMP Helpline and talk to Tiffany at 800-333-4374.