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Waynesboro squad dropping ambulance subscriptions

December 30, 1999|By RICHARD F. BELISLE, Waynesboro

WAYNESBORO, Pa. - Fearing lawsuits, members of the Waynesboro Ambulance Squad Inc., are dropping a subscription program that offered area residents substantial savings for ambulance service.

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The program, which has been in effect for nine years, ends Jan. 1. With it goes cheap ambulance service for nearly 4,000 residents who paid an annual subscription fee of $15 for individuals and $25 per family.

The squad serves about 20,000 residents in Waynesboro and parts of Washington and Quincy townships. The subscriptions allowed the squad to waive the difference between what Medicare pays and the squad's flat $250 rate per ambulance call.

Medicare patients account for more than half of the squad's ambulance runs. Ambulances go out about 155 times a month.

The subscriptions give free service to non-Medicare patients who would otherwise have to pay the full $250 flat rate per ambulance call, said Cheri Rock, vice president of the squad.

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Subscriptions are even more critical for patients with chronic medical problems who need repeated transportation to the hospital, she said.

According to Hans Bader, billing liaison officer, the subscription program is being scrapped because it opens the squad up to lawsuits over violations of Medicare regulations.

Six Pennsylvania municipalities operating ambulance services, including Chambersburg, have been named defendants in a Medicare fraud suit filed by a whistle-blower, according to the June 1999 issue of the Journal of Emergency Medical Services. The suit claims the ambulance squads routinely failed to bill Medicare patients for the 20 percent co-payment required by federal law.

Medicare is the federal health insurance program primarily for people 65 and older.

According to Bader, Medicare limits the amount its Waynesboro patients can be charged to $193 and pays 80 percent, or $161, of that amount. Waynesboro waives the $32 difference for those who subscribe to its service.

Subscriptions are common practices among private and nonprofit ambulance services, Bader said. All of the county's ambulance squads run subscription programs, but Waynesboro is the only one dropping it.

"A whistle-blower or anyone could file a suit against us. One of those suits in Pennsylvania is seeking $10,000 for each transport where the co-payment was sought. If that happened to us we'd have to close up shop," he said.

The local squad is eligible to apply for a waiver of the Medicare rule from the U.S. Department of Health and Human Services, a move Bader said the squad would consider.

"This hasn't been an easy decision for us," Rock said. "We did a lot of research and asked our attorney for advice and he recommended that we drop the subscriptions to avoid a lawsuit."

Subscriptions bring in about $45,000 a year, a big chunk of the squad's $125,000 annual budget.

Until the mid-1990s the squad ran fund drives and offered free ambulance service. Increasing costs forced it to go to subscriptions.

Bader said Medicare is becoming more selective in what it sees as necessary ambulance runs. "They're scrutinizing claims under a magnifying glass today. We have to justify everything. Physicians have to fill out medical necessity forms if we are to get paid," he said.

The squad pays a firm to do its billing. Bad debts are up to 5 percent today and are expected to increase above that now that the subscription program is being dropped, Rock said.

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