Here is an unusual one… a lawyer in Texas lost her license to practice law because of a Medicare fraud conviction. Gwendolyn Climmons not only can’t practice law, she can’t even use her name in conjunction with the words “lawyer” or “attorney.” According to court records, Climmons was sentenced to 8 years in prison for her role in a Medicare fraud scheme.
Climmons was indicted in 2012 in connection with a Medicare fraud scheme involving Urgent Response EMS, a Houston area ambulance company. The FBI claimed that Urgent Response billed Medicare for ambulance services that were either not medically necessary or in some cases, not even provided. Last June she was convicted of conspiracy to commit healthcare fraud and four counts of health care fraud. Each count carries a 10 year maximum sentence unless a patient dies or is harmed by the fraud.
Despite facing 50 years in prison, Climmons was recently sentenced to 97 months in federal prison, followed by three years of supervised release. She was also ordered to pay $972,000 in restitution. The FBI claims that she had submitted $2.4 million in fraudulent claims to Medicare.
We were surprised to learn that after her conviction, Climmons contested the suspension from the State Bar of Texas. Despite having filed an answer seeking to keep her license, she failed to appear at the hearing.
Medicare fraud is a huge problem in Houston. The Centers for Medicare and Medicaid Services claim that Houston has one of the highest Medicare fraud rates in the country. (The region shares that dubious honor with Miami and Detroit). Things became so bad last year that the feds placed a moratorium on new ambulance companies being able to register for Medicare in Houston.
It’s not just Houston that has a big problem with EMS Medicare fraud. Philadelphia may be the worst in the nation.
Typical EMS Medicare fraud schemes include:
- Billing for Advanced Life Support (ALS) services when only providing BLS services (basic).
- Administering an unnecessary IV or medication simply to make the trip appear to require ALS.
- Using unqualified or underqualified personnel and billing for paramedics.
- Using ambulances as glorified taxis (frequently at the request of hospitals or nursing homes).
- Using ambulances to transport dialysis patients for treatment (most can walk or use a wheelchair van).
- Transporting otherwise healthy people to dialysis appointments by ambulance.
- Accepting or paying kickbacks in return for lucrative exclusive hospital or nursing home business arrangements.
- Billing Medicare for transporting elderly nursing home patients that never even left the facility (phantom rides).
Most Medicare fraud cases come to light because of whistleblowers. Those whistleblowers that file a lawsuit in federal court under the federal False Claims Act can be awarded up to 30% of whatever the federal government collects. Because the law provides for both triple damages and up to $22,000 per false bill submitted to Medicare, the rewards can be staggering.
Ambulance scams are a common method of Medicare fraud. Despite numerous prosecutions, we continue to see disreputable operators bill for transports never performed, mark up basic transports as “advanced life support” runs and even billing for phantom ambulance transports that never even happened.
Recently the federal government began cracking down not only on ambulance companies that transport “healthy” patients on the taxpayer’s nickel but also on hospitals. Some hospitals use private ambulances as taxis simply to get people home or back to nursing homes so they can free up bed space.
Many whistleblowers have already received rewards for reporting EMS Medicare fraud. 29 states and the District of Columbia have their own state false claims acts that also pay for information on Medicaid fraud.
Worried about retaliation? Congress put robust anti-retaliation provisions in the law that prohibit companies from firing, demoting or harassing whistleblowers. Companies that disobey the law are liable for double lost wages, future lost pay and attorney’s fees.
Want to learn more? Visit our Ambulance / EMS Fraud cornerstone page. There you will find all the latest news on EMS fraud schemes.
Think you have information about Medicare fraud? Give us a call. We have helped our whistleblower clients collect over $100,000,000.00 in award monies and have helped the government collect billions on behalf of taxpayers. For more information, contact attorney Brian Mahany online, at or by telephone at (202) 800-9791. All calls protected by the attorney – client privilege and kept in strict confidence. (Before you call, remember not to use your work phone or email to contact a lawyer.)
MahanyLaw – America’s Medicare Fraud and Whistleblower Lawyers
** Update – After being charged with the EMS Medicare fraud, a Houston state court prosecutor charged Gwendolyn Climmons-Johnson with defrauding a litigation funding company of $400,000. The company’s owner says the company will likely go under because of the fraud.