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Pondera FraudCast

Welcome to the Pondera FraudCast, a weekly blog where we post information on fraud trends, lessons learned from client engagements, and observations from our investigators in the field. We hope you’ll check back often to stay current with our efforts to combat fraud, waste, and abuse in large government programs.

Ambulette Fraud

Ambulette Fraud

“Ambulette” is a term to describe the vans and cars that transport Medicaid patients to non-emergency appointments. Despite the presence of ambulettes, millions of Americans continue to miss medical appointments each year because of transportation problems. One possible answer to this problem? Rideshare companies like Uber and Lyft who sign agreements with hospitals and medical groups.

In my opinion, however, rideshare companies should proceed with caution. Fraud is rampant in Non-Emergency Medical Transportation (NEMT) and the under-the-table cash temptations may prove too strong for some drivers to ignore. Kickback schemes, billing for rides never actually given, illegal referrals, and providing rides to deceased patients are common NEMT fraud schemes.

The Centers for Medicare and Medicaid Services (CMS) recently gave a presentation on NEMT compliance and reporting requirements (which are the responsibility of the rideshare companies) and common fraud schemes. In one, a Medicare beneficiary drove patients to dialysis appointments but also provided the medical IDs to an ambulance company so they could bill as well. In another, a parent was jailed 30 days for billing Medicaid for trips for her child’s treatments. Although the parent was authorized to transport her child, the trips never actually took place.

It’s not easy for ridesharing companies to monitor their drivers’ behaviors, especially because of the flexible driver contracts and work hours. Combine this with NEMT fraud fines that often run into the hundreds of thousands of dollars and it is clear that rideshare companies may be opening themselves up to some serious problems.

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Pondera leverages advanced prediction algorithms and the power of cloud computing to combat fraud, waste, and abuse in government programs.



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