Healthcare Transportation Claim from the Twilight Zone

Despite auditing paid healthcare claims for more than 25 years, Healthcare Horizons and our clients continue to be stunned by some of our findings.  But this recent one seems out of this world. We identified a ground ambulance transportation claim for a patient with an orbital fracture. The patient was transported 45 miles for treatment. We suspect that no one would ever imagine the transportation provider filing a claim exceeding $10,000 per mile – but they did! More startling than the claim amount was the fact that the employer’s third-party administrator paid the transportation provider over $455,000, which is more than $10,000 per mile!  Finally, and most shockingly, the TPA initially defended the payment as correct.

It pays to have comprehensive medical claims audits!

Healthcare Horizons is a leading expert in providing healthcare claims audit services, identifying overpaid or erroneous claims through its 100% Difference model, and recovering millions of dollars for clients’ bottom lines with uncompromising ethics and accuracy. Since 1999, the Knoxville, Tennessee-based company has provided superior healthcare claims audits for the world’s largest self-insured employers, involving all national payers. We have successfully identified and facilitated the recovery of millions of dollars of overpaid claims for employers.