Medicare fraud cases ebb and flow, just like many things in life. The Department of Justice and the Centers for Medicare and Medicaid Services have been focusing on ambulance providers over the last several years, so much so that there have been moratoriums on approving new ambulance companies in Philadelphia and Houston. Whenever that much attention is focused on one industry group, the fraudsters tend to hibernate and hide.
The Justice Department is prosecuting EMS Medicare fraud cases across the United States and has even decided to seek prison sentences against some ambulance operators. We have seen cases where regulators will shut down one shoddy operator only to have the owners file bankruptcy, buy back their own equipment and simply re-letter the trucks.
There are many different types of Medicare fraud involving ambulances, they 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).
- Transporting otherwise healthy people to dialysis appointments by ambulance.
A released last month shows a new variation of Medicare fraud — taking people to sites where the patients didn’t actually receive any Medicare services. According to the Health and Human Services’ Inspector General’s Office, that “service” cost Medicare $30 million in the first half of 2012. (Unfortunately, that is the most recent data.)
Medicare is now extending moratoriums on new EMS services to New Jersey, Illinois, Florida, California and Michigan. Unfortunately, the moratorium hurts legitimate operators as much as the fraudsters.
By extending the moratoria, auditing more ambulance companies and criminally prosecuting a few bad apples, Medicare will win the battles for now. Within a few years we expect new EMS whistleblower opportunities will dry up, at least for a few years.
The 2012 study took so long to produce because it analyzed 7.3 million ambulance transports performed between January and June of 2012! This means current statistics are hard to determine. The spate of new criminal indictments and whistleblower complaints show that for now, there are still opportunities to collect meaningful awards.
Medicare Fraud and Whistleblower Awards
Of great interest to would be Medicare fraud whistleblowers should be the rewards payable by the Justice Department. Under the federal False Claims Act, the government can pay a whistleblower up to 30% of whatever the government collects from the wrongdoer. There are a few catches, however.
First, to receive an award you must have inside, original source information.
Second, you must file a lawsuit in federal court. (The suits are secret while the government is investigating them.) Calling the Medicare fraud hotline does not get you a big cash award.
Third, you must be first to file. Wait too long and chances are good that someone else may be the first to report your information.
Although Medicare is catching up with the current crop of fraudsters, there is generally a 6 year statute of limitations. (The law is a bit more complex but for discussion purposes, we will say 6 years.) Even if your employer cleaned up its act today, it remains on the hook for all the bad things done over the last several years.
Medicare fraud is a huge problem that costs taxpayers tens of billions of dollars annually. It is not a victimless crime and it prevents vital healthcare dollars from being spent where they are most needed.
We have helped our whistleblower clients collect over $100 million in award monies. If you have information about Medicare fraud of any type, now is the time to call. Don’t wait another day.
For more information, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct).
MahanyLaw – America’s Medicare Fraud Lawyers