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.