The manager of a southern California ambulance company will spend the next six and one half years in prison. Thirty four year old Wesley Kingsbury was convicted of Medicare fraud. Prosecutors claim that Kingsbury and others falsified records and improperly billed Medicare for transporting patients to and from dialysis appointments.
We have seen a huge uptick in Medicare fraud ambulance prosecutions in recent months. The Justice Department has been using both criminal healthcare fraud charges and the federal False Claims Act to pursue ambulance companies that attempt to bill Medicare for the transportation of otherwise ambulatory patients.
Patients are free to hire an ambulance for trips to dialysis or appointments but Medicare will only pick up the tab if there is a specific medical necessity justifying use of an ambulance. We have several on-going investigations where EMTs and paramedics tell us that patients walk themselves to the stretcher or into the hospital!
In Kingsbury’s case, court records reveal that he was general manager of Alpha Ambulance Inc. Between 2010 and 2012, Kingsbury conspired with Alpha’s owners to bill Medicare for transportation of patients who did not require an ambulance. EMTs working on the ambulance were instructed to alter paperwork and create false medical justifications.
In 2012, Medicare selected Alpha for an audit. Prosecutors claim that Kingsbury altered patient records and shredded the originals. In addition to conspiracy to commit healthcare fraud, Kingsbury was also convicted of conspiracy to obstruct a Medicare audit and making false statements to federal law enforcement officers.
The owners of Alpha Ambulance were previously sentenced for their roles in the Medicare fraud case. They received prison sentences ranging from 30 months to 108 months.
Kingsbury case was a criminal prosecution. Most ambulance Medicare fraud cases are prosecuted civilly under the federal False Claims Act. That law allows whistleblowers with inside information of wrongdoing to receive an award based on how much the government collects from the wrongdoers. Because the law provides for triple damages and up to $11,000 for each false claim submitted to Medicare, the rewards can be substantial. Awards of $1 million or more are very common.
Recently the government has begun prosecuting nursing homes and hospitals that conspire with ambulance companies to transport otherwise ambulatory patients.
If you information about Medicare or Medicaid fraud, consider becoming a whistleblower. Most of our clients do so simply because it is the right thing to do. Money is not the primary motivation. For that reason, we believe whistleblowers are the true heroes.
Medicare fraud is not only illegal; it also costs taxpayers billions annually. In some cases, it is often harmful to patients.
We are aware of one case in where a hospital was giving ambulance companies kickbacks to induce them to take emergency patients to their hospital. Very sick patients often had to suffer for longer periods of time as the ambulance bypassed closer hospitals. We also know of legitimate ambulance companies that can’t compete because so many shady operators are receiving kickbacks or behaving illegally.
Need more information? Contact attorney Brian Mahany at or by telephone at (direct). All inquiries kept strictly confidential. See also our updated ambulance fraud page. We have helped our whistleblower clients collect over $100 million in reward monies.