Ambulance Fraud: The Most Expensive Ride of Your Life

False Claims Act , Healthcare Fraud

Ambulance fraud is a False Claims Act violation that can take on many forms. Common types of fraud include emergency transport companies fraudulently charging Medicare or Medicaid for rides that are not eligible for reimbursement or upcoding in order to receive higher reimbursement not justified by the ambulatory services provided. These schemes result in a heavy monetary burden on our healthcare system, defrauding our healthcare system and stripping it of much-needed funds that could be legitimately used elsewhere.

Medicare has strict guidelines as to which beneficiaries are eligible for emergency transport. Ambulance services are only covered if they “are furnished to a beneficiary whose medical condition is such that other means of transportation are contraindicated.” Ambulance services are not qualified for reimbursement if the recipient is either self-ambulating and can seek alternate transportation such as a shuttle or personal vehicle, or if the ride is considered “non-emergent,” such as rides to doctor appointments.

Medstar, a Massachusetts-based ambulance service, settled a false claims case in January 2017 by agreeing to pay $12.7 million for fraudulently billing Medicare for services that were either ineligible or not provided. The case was brought to light by a previous Medstar employee, Dale Meehan, who was employed as a Medstar patient account representative. Meehan reported that Medstar had been fraudulently billed Medicare for services that were not medically necessary.

One allegation in the complaint entailed a patient being transported from a nursing home to a urologist appointment, and Medstar billing Medicare $1,130 for the service. Even more egregious, many ambulance trips were billed to both the patients and the federal health programs. Similarly, another common practice included billing Medigap and Medicare for the same services. When she brought these allegations to her supervisors in an attempt to reverse the claims, she was reprimanded and later terminated from her position. Meehan received $3,556,000 under the qui tam provision of the False Claims Act for coming forward as a whistleblower.

Whistleblower Justice Network Can Help You

Whistleblower Justice Network partners with whistleblowers throughout the United States in efforts to expose ambulance fraud schemes that violate the False Claims Act. We work alongside those who bring forward information in an attempt to do what is morally right and, in turn, recover government funds so they may be allocated properly.

If you have meaningful information regarding ambulance fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.

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