Morrison Mahoney Of Counsel Doug McInnis will be a presenter at the New England Association of Insurance Fraud Investigators seminar on February 9.
Doug's topic is "Chasing Ambulances: A Look at Improper Cost Shifting to Private Insurers."This presentation examines improper cost shifting methods committed by emergency medical technicians (EMTs) and ambulance companies that result in improper charges to third-party payers. These improper cost shifting methods include duplicative charges, upcoding the level of care rendered, billing for services rendered by unqualified personnel, billing for services that were not medically necessary, and billing for services that were not rendered. One of the most effective shifting methods for ambulance companies, upcoding, involves misrepresenting the level of care rendered to patients from Basic Life Support (BLS) to Advanced Life Support (ALS). ALS receives the highest level of payment from insurers and usually involves invasive techniques, such as intravenous and intubation. ALS must be rendered by a licensed Paramedic. In contrast, BLS involves non-invasive techniques and may be performed by a licensed Basic EMT.
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