The Medicare program requires ambulance providers to sign an enrollment application that expressly states the provider will not knowingly submit false or fraudulent claims to Medicare or claims with deliberate ignorance or reckless disregard for their truth or falsity. The Medicare program only intended to pay for ambulance services that were provided and medically necessary. Medicare did not intend to pay for ambulance services provided by vans or taxis or for beneficiaries who, at the time of transportation, could safely be transported by other means.
Hospitals in Jacksonville Florida that have been sending patients home from the hospital by ambulance have agreed to pay $6.25 million to Uncle Sam and the ambulance company another $1.25 as the Government determined that ambulances were not needed as there was no emergency. The hospitals involved included Baptist Medical Center, Downtown, Baptist Medical Center South, Baptist Medical Center Beaches, Baptist Medical Center Nassau, Memorial Hospital, Orange Park Medical Center, Specialty Hospital Memorial Health, Lake City and UF Health.
Jason Mehta, an Assistant United States Attorney began his investigation into Medicare billing by ambulance after a whistleblower lawsuit was filed by Shawn Pelletier, an EMT since 1998 who worked for Century and Liberty ambulance companies. He said he saw documents being falsified for Medicare billing.
Mehta noticed that the majority of non-emergency ambulance rides originated from the hospitals. Most of those rides ended at nursing homes. Although the hospitals did not gain financially from billing Medicare for the ambulance runs, they gained by opening up rooms to be filled more quickly with other patients. According to Mehta the rate at which ambulance transport expenses are increasing is about twice the rate of other medical expenses increases.
Lafferty Enterprises doing business as Trans-Star Ambulance Services will pay $948,000 to resolve allegations ambulance s that it filed fraudulent claims with the federal Medicare program. Medicare will only pay for an ambulance to take patients to and from dialysis if other forms of transportation pose a medical risk, and that was not the case in this instance, the government argued. This settlement is just one of scores of similar cases and recent Government allegations that ambulance companies are engaged in massive fraud by over-billing Medicare and Medicaid and also charging for services that are not allowed. In many instances, for example, the ambulance companies are billing for advanced care life support when the ambulance run does not provide advanced services.
As part of the settlement, Trans-Star will also have to undertake “substantial internal compliance reforms” and its claims will be reviewed by a third party for the next three years.
“It is vitally important that the resources available to federally funded healthcare programs be used only to pay for medically necessary services,” Kerry B. Harvey, U.S. Attorney for the Eastern District of Kentucky, said in a news release. “Our office and our agency partners are committed to protecting the integrity of these important programs on which so many of our citizens depend.”
The United States Department of Health and Human Services has revealed new data showing that Medicare overpaid ambulance providers by $314 million last year and over a third of that was for unnecessary claims for the elderly and disabled., with rides to dialysis centers and doctors offices. Approximately one third of ambulances billing Medicare are for-profit suppliers.
Under the present regulations, dialysis patients must get treatments three days a week while while waiting for transplants and Medicare will pay for non-emergency ambulances but only for those so ill they can’t get to their medical appointments or treatment any other way. Ambulances are not supposed to be used by people who can walk, sit or ride in a wheelchair. They must find transportation by van or taxi.
Of $5 billion spent on ambulance trips in 2011, $700 million was for rides to dialysis centers. HHS estimates that Medicare would save more than $400 million per year if those states spending the most on ambulance rides per dialysis patient were brought down to the average levels. Those states include Massachusetts, WEst Virginia, South Carolina, New Jersey and Pennsylvania.
An ambulance company and its employees were charge with conspiracy to commit health care fraud this week by the Federal Government, which also took the unique step of charging patients who were allegedly getting paid to take the ambulance trips.
The U.S. Attorney’s Office charged four individuals with allegedly accepting kickbacks from Brotherly Love Ambulance of Northeast Philadelphia as an inducement for accepting medically unnecessary ambulance rides from the company.
Also charged was two Brotherly Love Ambulance Co. employees,Fritzroy Brown, 37, and Thael Kuran, 22, both of Philadelphia, with conspiracy to commit health care fraud and making false statements in connection with health care matters.
First Call Ambulance Service paid the Government $500,000 to settle allegations that it violated the False Claims Act, according to David Rivera, U.S. attorney for the Middle Districtof Tennessee. The settlement resolves allegations by the United States and Tennessee that First Call up coded billings for ambulance transports provided to patients covered by federal healthcare programs and TennCare, Tennessee’s joint state/federal Medicaid program.
Specifically, the United States and Tennessee alleged that First Call submitted false claims for payment covering advanced life support services for its ambulance runs. For many transports billed as ALS, First Call’s provision of ALS services was medically unnecessary, or First Call did not actually provide ALS services. Instead, only basic life support services were necessary, and in some cases were the only services provided. BLS services are billed to federal health insurance programs at a lower rate than ALS services. Continue reading
Valeriy Davydchik, 59, a Russian immigrant driver for Penn Choice Ambulance Inc. in Philadelphia charged Medicare $400 for every round trip to a kidney dialysis center, and each patient required three visits a week, a single customer could generate nearly $5,000 a month. The reimbursements are intended to provide service to patients who can not walk or otherwise travel safely for treatment.
Davydchik’s patients, who included his wife, were able to walk. To cover for the fraud, the patients were asked to climb onto a gurney to be wheeled to the ambulance. One of the patients, according to court papers, rode next to him in the front passenger’s seat while smoking. Penn Choice billed Medicare $100,000 for that patient alone, according to court papers.
Davydchik’s patients get free rides and they received kick-backs in return for their continued patronage, prosecutors said. Continue reading