Medicare fraud by ambulance companies is epidemic! The problem has become so bad that regulators can’t keep up. Last year Medicare and Medicaid officials in Philadelphia and Houston were forced to issue a moratorium on new registrations of ambulance companies.
What is the problem? It’s either “up coding” or billing Medicare for transports of people who are ambulatory. Using ambulances for taxis to and from nursing homes, hospitals and dialysis clinics and billing normal transports as advanced life support runs are common scenarios. They are also illegal.
This month five more ambulance companies agreed to collectively pay more than $11.5 million to the government to settle Medicare fraud charges. Included in the settlement are Pacific Ambulance, Inc., Bowers Companies, Care Ambulance, Balboa Ambulance Service and E.R. Ambulance. All five companies are located in southern California.
The companies were accused of engaging in illegal kickbacks. The Justice Department claimed that the companies provided deeply discounted services to hospitals and nursing homes in exchange for exclusive contracts to transport the more lucrative Medicare patients. These types of kickbacks are commonly called a “swapping” scheme.
Medicare fraud rules prohibit any type of kickback scheme. By entering into exclusive arrangements, Medicare believes that ambulance companies are more likely to overuse ambulance transports and overcharge as well. There is pressure on the companies to make up any losses from the discounted transports.
Federal law prohibits payment arrangements that are intended to influence health care referrals. The statute generally prevents anyone from offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare.
In announcing the settlement, an FBI spokesperson said, “Protecting the integrity of the Medicare program so that it can continue to provide health care for its patients is a priority of the FBI.” In a media release, an HHS spokesperson said, “Today’s settlements resolve a thorough investigation of the practices by ambulance companies that offered significant discount services to facilities in exchange for patient referrals.”
The case was filed by a whistleblower, Kelvin Carlisle. Unlike most Medicare fraud cases, which are filed by concerned employees, Mr. Carlisle owns a competing ambulance service. He filed after being essentially being locked out of the lucrative hospital and nursing home business because he wouldn’t break the law.
For his efforts, Carlisle will receive in excess of $1.7 million.
Whistleblowers under the federal False Claims Act are eligible to receive up to 30% of whatever the government collects from wrongdoers. The average award is typically 15 to 18%.
Medicare fraud costs taxpayers billions of dollars each year. Worse, because budgets are so thin, overbilling often means that there are not enough resources for the truly needy. Thankfully, whistleblowers have stepped up in record numbers to put a stop to both Medicaid and Medicare fraud. Last year the Justice Department paid whistleblowers $635 million in awards. (Our clients received over $100 million.)
To qualify for an award, one must simply possess inside, “original source” information about fraud involving a government funded program. Because Medicaid and Medicare receive federal funds, both programs qualify. EMTs, paramedics and billing clerks are ideal whistleblowers.
EMS and billing professionals that blow the whistle are protected by robust state and federal whistleblower anti-retaliation protections. Under federal law, employers are prohibited from firing, demoting or harassing anyone blowing the whistle. Remedies include double lost wages, future lost wages and attorney’s fees. (The latter provision makes it much easier to find a lawyer.)
For more information, contact attorney Brian Mahany at or by telephone at (202_ 800-9791. See also our ambulance Medicare fraud page. All inquiries are protected by the attorney – client privilege and kept strictly confidential.
MahanyLaw – America’s Whistleblower Lawyers