Double Daniels Ambulance: False Patient Records, Then Medicare Money

The Double Daniels ambulance fraud case involved approximately $1,713,716 in false Medicare claims for medically unnecessary and unprovided ambulance services, according to the Justice Department’s account of the criminal trial. A federal jury convicted the company’s owner/operator. The Justice Department described falsified patient records supporting the claims and Medicare payments moving through the company to the operator and others.

Double Daniels LLC operated in the Houston area, offering non-emergency ambulance services to Medicare beneficiaries. The Justice Department’s March 5, 2013 announcement described a scheme running from April 2010 through December 2011.

Unnecessary Ambulance Services and Transports Never Provided

Double Daniels’ criminal case reached two points in Medicare billing: whether ambulance care was needed and whether the billed service was provided. Where the service was never provided, the account of the trip itself is false. Where ambulance transport was unnecessary, the patient’s actual condition matters to why Medicare was billed.

The Health and Human Services Office of Inspector General’s ambulance review explained the payment principle in plain terms: the patient’s condition at the time of transport must make other means of transportation dangerous to the patient’s health. That puts the focus on the person who needed care, rather than the availability of an ambulance or the existence of an appointment.

We see the absurdity: change the paperwork, manufacture the medical need. Taxpayers pick up the bill.

False Patient Records Made the Claims Look Payable

The Justice Department said trial evidence showed that the Double Daniels owner/operator falsified patient records to support fraudulent Medicare billing. The operator both submitted claims and caused claims to be submitted. The evidence reached the creation of the medical record as well as the demand for payment.

In ambulance work, the run report carries the crew’s account of the patient and the transport. It can connect the reason for the trip, the patient’s condition, the pickup and destination, and the services provided. Falsified ambulance run reports turn that clinical account into support for a claim the actual trip cannot justify.

The inspector general’s ambulance guidance names dispatch instructions, the reason other transportation was unsuitable, who ordered the trip, mileage and services provided among the information suppliers should record. It also warns against filling gaps or resolving contradictions in a trip sheet with assumptions. That makes the crew’s actual observations important: a billing explanation added later may tell a different story from the one recorded during the ride.

For a crew member, the meaningful difference may be between the patient they saw and the description that later supported billing. For someone in the billing office, it may be the explanation used to make the service payable. We look at those accounts together because a change in the patient story can change the reason Medicare is being asked to pay.

The same medical-necessity question matters in dialysis ambulance billing, where appointments bring patients back for recurring treatment. The need for dialysis does not supply the need for ambulance transport. A signed physician certification statement also needs supporting evidence of medical necessity.

A Car Ride on an Ambulance Run Sheet

A separate criminal case shows how far the gap between a ride and its paperwork can go. In the Justice Department’s account of a Brotherly Love ambulance driver’s guilty plea, the driver admitted transporting patients in his personal vehicle and a company minivan. Both lacked the lifesaving equipment found in an ambulance. He still completed ambulance run sheets for trips in his own car and certified them with his signature.

The run sheets misstated the patients’ medical conditions and the care provided to make the rides appear to have been ambulance transports. After Brotherly Love ceased operating, the driver completed false, inconsistent run sheets at its successor, VIP Ambulance. The company’s name changed. The false paperwork continued.

For an employee, that example puts the vehicle, the care and the signed account of the trip alongside each other. Someone who knows what vehicle left the station may know something the claim never reveals.

Houston’s Ambulance Billing Under Scrutiny

Houston-area beneficiaries accounted for 8.3% of the nation’s questionable ambulance transports but 1.8% of all ambulance transports in the first half of 2012, according to the inspector general’s September 2015 report. That comparison shows why the Houston market drew scrutiny beyond any single operator.

The report analyzed claims for 7.3 million ambulance transports. One measure compared the ambulance claim with Medicare services at the stated pickup or destination. A high share of trips without those corresponding services could point investigators toward transports never provided or trips to destinations Medicare did not cover. OIG used those measures to identify suppliers for further investigation.

The report also exposed a gap in certification oversight: claims data did not identify the physicians who certified the medical necessity of questionable transports. OIG wanted the certifying physician’s identifier included on the claim and the certification. The same OIG report records that Medicare suspended new ambulance-supplier enrollment in the Houston area in July 2013.

Who Is Responsible for Medicare Fraud?

In the Double Daniels case, a federal jury convicted the owner/operator of one count of conspiracy to commit health care fraud and six counts of health care fraud. The Justice Department’s account of court documents says the owner/operator transferred fraud proceeds to himself and others after Medicare sent payments to Double Daniels. An employee familiar with the company’s finances could recognize that last part without having written a patient record. The FBI, HHS-OIG and the Texas Attorney General Medicaid Fraud Control Unit investigated the case.

What an Insider Could Recognize

The Double Daniels case connects patient records, submitted Medicare claims and the movement of payments. An insider’s knowledge can sit at any of those points. A crew member may know how the patient actually traveled. A billing employee may know which documents supported the claim. Someone handling company finances may know who received the payments afterward. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What the Claim Left Out

If you worked at Double Daniels or recognize the same split between patient records and Medicare claims elsewhere, speak to one of our Whistleblower Experts about how those claims got paid. We put your knowledge of the records and payments at the center of your strongest ambulance fraud whistleblower case and bring in ambulance fraud whistleblower lawyers who know Medicare billing. Our experts stay with you as that case moves forward.