Medicare

Volunteer ambulance companies often transport Medicare patients to hospitals. In some cases, the patient may require the services of a paramedic trained in advanced life support services. GAO found that Medicare contractors rely on states to certify ambulance companies for participation in the Medicare program, and states set their own certification requirements. Most volunteer ambulance companies do not charge for their services or have their own paramedics. Medicare does not pay separately for paramedics, who are covered only if they are an integral part of the ambulance service. Although data are limited, GAO believes that the potential liability of Medicare beneficiaries for paramedic services may be substantial. For example, two providers of paramedic services in Connecticut charged Medicare patients in excess of $600,000. The Health Care Financing Administration (HCFA) has tried to minimize this liability by allowing ambulance companies to submit a single bill to Medicare for both the ambulance and paramedic services. Because volunteer ambulance companies seldom bill for services, however, this arrangement may not help patients minimize their liability. HCFA officials have agreed to reexamine their policy but as of March 1994 had not yet reached a decision on this matter.

GAO found that: (1) Medicare contractors rely on states to certify ambulance companies for Medicare participation; (2) most volunteer ambulance companies do not charge for their services or have their own paramedics; (3) a high proportion of those served by volunteer ambulance companies are elderly persons; (4) Medicare does not pay separately for paramedics as secondary responders; and (5) Medicare beneficiaries may be liable for paramedic intercept services.