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!