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EXECUTIVE SUMMARY:
The objective of this partnership review was to determine the allowability of Medicaid claims submitted by ambulance providers for emergency and non-emergency transportation services provided to recipients during an inpatient hospital stay. Using a computerized detection routine developed by the Illinois Department of Public Aid’s (IDPA) Office of Inspector General, the partnership identified thirteen ambulance providers who submitted claims for transportation services when the recipient was hospitalized. According to Chapter T-204 of IDPA’s Handbook for Providers of Transportation Services, payment will not be made for a hospitalized patient transported to a second hospital for outpatient services not available at the hospital of origin. Because hospitals typically bill after coinciding transportation bills are submitted, prepayment edits by IDPA would not detect transportation services provided to recipients during an inpatient stay. These 13 ambulance providers were paid $178,294 for unallowable transportation services provided during the period April 1, 1999 to March 31, 2002.