Life Support Ambulance: Personal Vehicles, Ambulance Bills

Life Support Ambulance’s false medical-necessity billing scheme drew more than $1.9 million from Medicare, according to the Justice Department’s account of the criminal guilty pleas. The scheme included personal-vehicle trips billed as ambulance rides, false medical-need reports and patient kickbacks to keep patients coming back. For an employee who knew the patients, drove the vehicles or handled the claims, the difference between the ride and the bill was something they could see. The company was Life Support Corporation, formerly located in Feasterville-Trevose, Pennsylvania.

How the Life Support Claims Were Built

The criminal plea announcement describes patients who could walk and travel safely by means other than an ambulance. In that account, the defendants, or people acting on their behalf, falsified reports to make those patients appear to need ambulance transportation. The announcement says the defendants and their employees knew the patients could safely travel another way. The person recording the patient’s condition could see the difference between the patient in front of them and the patient described for payment.

The personal-vehicle trips made the mismatch sharper still. The claim described an ambulance service even though the patient had traveled in a personal vehicle. The ambulance existed only on the bill.

The industry paperwork explains how a claim can carry that false account beyond the crew. A run report records the patient’s condition, why another mode of transportation was unsafe, the service level, trip times, mileage, pickup and destination, and the care provided. In its 2003 guidance for ambulance suppliers, the HHS Office of Inspector General told suppliers to gather those facts and warned personnel against filling gaps or contradictions with assumptions.

What Is Considered Medically Necessary for an Ambulance?

An ambulance is medically necessary when the patient’s condition makes other transportation unsafe and requires the level of service billed. The Medicare coverage rule ties payment to both the transportation itself and the care it requires. The condition at the time of the trip is what matters.

The Medicare Benefit Policy Manual says Medicare cannot pay for an ambulance when another method could be used without endangering the patient’s health, whether or not that alternative is actually available. Having no ride available does not create the medical need described on an ambulance claim. A signed physician certification statement also does not establish medical necessity by itself.

The Patient Kickback Bought the Next Ride

The Life Support kickbacks went to patients to keep them using the company’s ambulances. According to the criminal plea announcement, the payments were intended to stop patients from switching to another ambulance company. Patient choice was something the defendants paid to keep.

The payments and false reports served connected purposes. The kickback secured the customer. The report supplied the medical explanation for billing Medicare. An insider who saw an offer to a patient and an insider who saw the resulting claim would be seeing different parts of the same business arrangement.

That differs from the facility discounts described in the government’s ambulance swapping cases. There, the government alleged that ambulance companies offered deeply discounted, often below-cost trips to hospitals or nursing facilities in exchange for exclusive Medicare referrals. In Life Support’s criminal case, the inducement reached the person taking the ride.

The Company, the Owners and the Manager

Life Support Corporation pleaded guilty to conspiracy to commit health care fraud on November 6, 2014. The Justice Department’s plea announcement identifies separate pleas by the owners and a manager: The owner from Jamison pleaded guilty to conspiracy to commit health care fraud and violating the federal anti-kickback law. The co-owner from Warminster entered his own guilty plea to the fraud conspiracy and anti-kickback violations.

The Manager From Philadelphia

The Philadelphia defendant was a company manager, and his plea also covered the fraud conspiracy and anti-kickback violations. The criminal case reached the operating management of the company as well as its owners.

The HHS Office of Inspector General and the FBI investigated the case. The U.S. Attorney’s Office for the Eastern District of Pennsylvania prosecuted it.

What Is an Example of Improper Documentation on a Patient Care Report?

A false account of the patient’s need for an ambulance is one example of falsified ambulance run reports. Life Support’s criminal plea announcement describes reports that made patients appear to need ambulance transportation even though the defendants and their employees knew they could safely travel another way. The vehicle mismatch in Life Support’s case also appears in the Justice Department’s account of a Brotherly Love Ambulance driver’s guilty plea, which describes personal-vehicle and company-minivan trips documented as ambulance services on signed run sheets.

What Evidence Does a Whistleblower Need?

For the conduct illustrated by Life Support, the useful evidence connects the patient’s condition and actual transportation to the report, the bill and the decisions behind them. A crew member may know how the patient moved and which vehicle carried them. A biller may know which description reached the claim. Someone involved in patient arrangements may know what was offered to keep the rides coming.

We look at those accounts together with the original report, later changes, the certification’s signer and date, and the service actually billed. The point is to explain how a trip became a claim and who knew the account was false. An instruction to change a report can make that connection visible. So can the gap between a signed run sheet and the vehicle the driver used. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What Happened on the Ride

If you saw a personal-vehicle ride become an ambulance bill, a patient’s mobility disappear from a report, or payments used to keep patients coming back, speak to one of our whistleblower experts about how the ride became an ambulance bill. We build your strongest ambulance fraud whistleblower case around the decisions and records you know. We bring in ambulance fraud whistleblower lawyers who understand medical-necessity and kickback cases, and stay with you through the pursuit of a recovery.