Reducing Costs & Improving Program Integrity for Medicare

Curbing non-emergency ambulance overuse

CMS needed to curb the overuse of non-emergency ambulance rides—a source of avoidable expenses that were driving up Medicare costs—while preserving access to medically necessary transport.

Assessing program integrity and care quality

We brought together evaluation, program integrity, clinical, and Medicare transportation experts to measure the impact of CMS's prior authorization model for non-emergency ambulance use. Our analysis examined effects on spending, service quality, and program integrity—using data from across a number of states.

Cost reductions achieved with no care disruption

Our multi-year evaluation helped achieve significant cost savings while safeguarding patient care. By analyzing Medicare claims, we showed that reduced spending on unnecessary non-emergency ambulance services would not compromise the well-being of Medicare beneficiaries. We found no negative impact on care access or quality, highlighting the demonstration’s success in reducing improper use while maintaining positive patient outcomes.

Key findings at a glance

• Saved $1 billion in Medicare costs (2015–2019)
• No reduction in access to medically necessary services
• Decreased total costs per beneficiary by 2.4%
• Provided evidence-based insights to inform CMS policy expansions