AUSTELL, Ga. - Thousands of Georgians require dialysis to do what their kidneys cannot -- clean their bodies of toxins.
Some of those patients admitted to the FOX 5 I-Team they don't really need expensive taxpayer-funded ambulance rides to get to their dialysis appointments.
This sort of pricy non-emergency ambulance service is supposed to be restricted to people who cannot get to dialysis any other way without putting their health in danger. Yet three times a week, a Caring Hands ambulance pulled up to the homes of Georgians who say they didn't need it. And those patients say Medicare paid for the trip.
For months the FOX 5 I-Team watched Caring Hands ambulances travel the streets of West Cobb, Douglas and Paulding Counties. They weren't handling 911 calls or other emergencies. These ambulances always headed to the nearest dialysis clinic. And if the patient was on Medicare, that meant an average $500 taxpayer-funded payment to Caring Hands for every round trip.
But how many really needed the ride?
"The ambulance service that carries a patient who can walk or who is not eligible for non-emergency ambulance knows exactly what they're doing. And knows exactly how they get paid," advised Rick Tibbetts, a former E-M-S owner and now consultant.
During our investigation, we repeatedly saw one Caring Hands patient climbing off the stretcher and walking up a flight of seven steps into her home after dialysis.
We watched another Caring Hands patient walk at least 20 feet to get to the stretcher waiting for her outside her home. We saw a man walk outside and climb onto the stretcher as well.
Two of those patients told me when they go to other doctors, they don't need a stretcher or an ambulance. They get rides from family members. They admitted they only need that Medicare-funded ambulance ride to dialysis... because it's just more convenient.
"They just threw it on me," explained one patient. "I ain't ask for it. I ain't did nothing. It's the only way they said I had transportation."
She and another patient admitted family members drive them to other medical appointments. They take the ambulance to dialysis because it's more convenient, and they wouldn't have to rely on relatives.
"That ambulance trip is not covered by Medicare," EMS expert Tibbetts pointed out.
"At least, it shouldn't be," I asked.
"Or it should not be covered by Medicare," he replied.
Rick Tibbetts spent 35 years in the business, starting as a paramedic, ultimately owning his own ambulance service in Troup County.
Now he heads up EMS Consultants in LaGrange, a company that handles billing for several ambulance companies. Tibbetts says he works hard to ensure they only process claims for patients who truly qualify.
"There's a lot of fraud through Medicare," he warned as we toured his large billing area. "Ambulances is just the tip of the iceberg but there's a lot of fraud I'm sure."
There are cheaper ways to get people to dialysis who don't have a ride. If they also qualify for Medicaid, the state and federal health program for the poor, patients can use a van service that takes them from door to door. They share the ride with other patients, but the one-way cost difference for taxpayers is striking.
"About 50 dollars versus 250 dollars," Tibbetts maintained.
"That's quite a savings," I remarked.
"Oh yes. 80 percent."
The ambulance company we watched -- Caring Hands EMS -- is run by Floyd Keels. His wife Shala is listed as the Chief Financial Officer. According to state corporation records, the two are also listed as officers for a Mableton dialysis clinic. That's where we watched several Caring Hands ambulances bringing in and picking up patients.
In fact, we saw no other ambulance providers on the two full days we watched. Yet according to Medicare, there's no rule preventing someone from operating both an ambulance service and a dialysis clinic.
When we dropped by Caring Hands office in Austell, Floyd Keels refused to answer any of our questions and asked me to leave the property.
So what's the answer? Medicare is trying something different. In some states, ambulance services must now get prior authorization from Medicare before billing for non-emergency trips. Is it working? Oh yes.
According to Medicare, under the old rules in those states -- when the government paid claims without asking for documentation first -- non-emergency ambulance billing averaged nearly $18.9 million each month. In the first year of the new rules, that number dropped nearly 75 percent... to $5.4 million monthly in the states that were part of the pilot program.
And in South Carolina, considered by the government as one of the biggest ambulance dialysis abusers, during that first year 20 ambulance companies went out of business.
"Out of 200 ambulance services in SC, that means that 10 percent went out of business because they could not carry people that did not go to dialysis, need to go to dialysis in ambulances," Tibbetts stressed.
"What does that tell you?"
"Tells me there's a lot of fraud."
Medicare wants to eventually make prior authorization the rule for all states, but at the moment, Georgia ambulance services operate under the old rules, taxpayers underwriting these red-light limo rides even some patients admit they don't really need.
"They should be shocked," Tibbetts warned. "Their tax money at work. They should be shocked."Tibbetts warned. "Their tax money at work. They should be shocked."