Instances of double and even triple billing of funds by a limited number of unscrupulous EMS providers are negatively affecting the image of the EMS industry. Such providers often invoice multiple funding sources for services rendered to the same patient, and relating to the same incident. In some cases up to three funding sources have been deliberately invoiced simultaneously for the same incident.
This fraudulent behaviour is not isolated to the EMS environment and occurs across the whole of the private medical sector. In order to combat it and restore their image, the private ambulance industry is encouraging schemes to take action in this regard and to work with them to root out the corrupt and unethical providers in their ranks.
The funds that are most commonly abused in this manner are medical aid funds, the Road Accident Fund (RAF) and the Compensation Fund for Occupational Injuries and Diseases (COIDA). In a number of instances a provider may be in a position to submit an invoice to all of those funding mechanisms, without any of them being aware that they are all being billed at the same time.
The opportunity for this type of behaviour has clearly been created due to a lack of communication between funders in the private healthcare industry. To rectify this communication breakdown, a simple database that issues a reference number in advance of an invoice being submitted, and that is available to all funders in the market, could be used.
The EMS provider would only be required to enter the patient name, surname, date of birth, date of service, and intended billing source into the database. A reference number would then be generated. The funder would then be in a position to log into the database, input the reference number, and ensure that the claim has not already been paid by an alternative funding source – or that they are indeed the intended recipient of the invoice. Once the claim is paid, the funder notes that they have settled the invoice.
A database such as this would work to the advantage of all funders in the industry and would be a system wholeheartedly supported by SAPAESA as well as all of the ethical EMS providers. SAPAESA strongly urges funders to engage in the development and establishment of such a database as soon as possible, in order to prevent corrupt and embarrassing activity within the EMS industry.