[Post updated July 2020] When this post was first written in 2015, a Kentucky ambulance company had agreed to pay almost $1,000,000 to settle charges of Medicare fraud brought by the U.S. Department of Justice. Prosecutors had accused Lafferty Enterprises, doing business as Trans Star Ambulance, of transporting patients to and from dialysis by ambulance even though an ambulance wasn’t medically necessary.
Trans Star must pay $948,000 under the settlement. The company was not required to admit any guilt.
The Trans Star case was brought by a whistleblower. Kevin Fairlie, the owner of a different ambulance company, alerted the government to the fraud by filing a complaint under the federal False Claims Act. Under that law, whistleblowers are entitled to keep up to 30% of whatever the government collects. In this case, Fairlie was awarded $189,600.
In announcing the settlement, U.S. Attorney Kerry Harvey said, “It is vitally important that the resources available to federally funded healthcare programs be used only to pay for medically necessary services. Our office and our agency partners are committed to protecting the integrity of these important programs on which so many of our citizens depend.”
We have seen similar cases of dialysis patients and medically unnecessary ambulance transports across the country in Detroit, Atlanta and Philadelphia. In some cases the problem is so bad that “patient recruiters” solicit dialysis patients to ride their ambulance to avoid driving. In another variation of this popular Medicare fraud scheme, patient recruiters and ambulance drivers troll clinics and nursing homes offering to transport patients to appointments.
In 2017, former employees of Mauran Ambulance and DaVita Doctors Dialysis of Los Angeles pled guilty to federal healthcare fraud charges involving a scheme in which Mauran transported dialysis patients to DaVita even though they didn’t require an ambulance. One of DaVita’s employees assisted in the scheme and received kickbacks in return. Prosecutors say that Medicare was overbilled by$6.6 million.
That same year a Texas EMS provider, Freedom Ambulance agreed to pay an $846,000 settlement over claims that it billed Medicare for transporting patients for dialysis. Once again, the trips were medically unnecessary.
In 2019, Medical Transport LLC of Virginia agreed to pay $9 million in another case of dialysis patients and medically unnecessary ambulance transports. The company was allowed to settle without admission of guilt. Despite “thousands” of ambulance transports, the company told a CBS affiliate that it made an “honest mistake.”
In 2020, federal prosecutors in Texas went after Tiger EMS for non-medically necessary transports between nursing homes and dialysis centers.
In one of the largest dialysis ambulance transport prosecutions, prosecutors in the U.S. territory of Guam sentenced two people to between 5 and 6 years in prison. Their crime? You guessed it, dialysis patients and medically unnecessary ambulance transports. The couple also has to pay almost $11 million in restitution.
Medicare is a federally funded program. Like Medicaid, which receives state funding, Medicare relies on tax dollars. Patients can take ambulances to appointments but only if it is medically necessary. Much less costly options are available for those that don’t or can’t drive such as van or taxi service.
Dishonest EMS providers love dialysis patients because they must seek treatment every few days. That means a single patient can generate tens of thousands of dollars in revenue for an ambulance company. Typically someone must fill out and sign a medical necessity form but forgeries re not uncommon. Worse, some unscrupulous healthcare workers except kickbacks in return for signing the forms.
Medicare fraud costs taxpayers billions of dollars each year. Whistleblowers are the government’s best line of defense. Last year, the Justice Department paid out $435,000,000.00 to whistleblowers under the False Claims Act.
If you have inside information about Medicaid fraud, Medicare fraud or any other misuse of taxpayer funds, give us a call. Our team of whistleblower lawyers helps ordinary individuals become heroes, earn the maximum awards possible and fight fraud. Typical claimants in Medicare fraud cases include medical coders, EMTs, billing specialists, IT personnel, patient recruiters and even physicians.
For more information, contact attorney Brian Mahany* at or by phone at . See also our EMS fraud cornerstone page. All inquiries protected by the attorney – client privilege and kept confidential.
MahanyLaw – America’s Medicare Fraud and Whistleblower Lawyers
*Brian is a former Emergency Medical Technician with the University of Delaware Department of Public Safety.