The Defense Health Agency improperly paid more than $100 million over five years for ambulance rides, which often lacked documentation to prove they were necessary, according to a Defense Department inspector general audit released Thursday.
After reviewing a statistically representative sample of 182 claims from October 2015 to September 2020, the Office of the Inspector General projected that, of the $358.1 million that the DHA paid for ambulance rides, at least $118.85 million — a third — was improperly paid.
Tricare, the health care program for service members, retirees and their dependents, covers civilian ambulance services when documentation proves they are necessary. But it does not allow beneficiaries to use ambulances when they are physically able to use other transportation.
The inspector general report says that the DHA — which manages military health services, including Tricare — failed to monitor its contractors to ensure their ambulance claims met Tricare’s reimbursement requirements.
One Tricare Overseas patient took an $880.72 ambulance ride, paid for by the DHA, because of a cancerous tumor of the mouth — not a medical emergency.
In another instance, the DHA, through its Tricare East contractor, paid $123.44 for an ambulance to take someone from his residence to an orthopedic clinic for a follow-up appointment for a fractured femur, even though the patient could move around on crutches. The report also noted that this patient had made 26 other ambulance claims, 11 of which were transports or mileage claims for rides to doctors’ offices.
In most of the cases investigators reviewed, however, the ambulance claims simply lacked the paperwork to prove the services were necessary.
The DHA’s compliance reviews of ambulance services do not evaluate the necessity of rides, according to the report. The report called on the agency to monitor its ambulance payments more closely and to recover the millions in improper payments.
In a response to a draft version of the report, the DHA agreed with the inspector general’s recommendations, although the final report said the agency did not provide enough specifics about how it will enforce requirements that its contractors document why ambulance rides are necessary.
The DHA declined to comment on the report by time of publication.