Ambulance Transports Never Provided: Claims Without the Ride

Ambulance transports not provided become false claims when a company knowingly bills for rides it never supplied, including trips the patient made by car, passenger van or public transit. The run sheet may describe an ambulance, a crew and care that bear little resemblance to the journey. If you drove the patient, dispatched the vehicle or handled the bill, you may know exactly where the account changed.

Medicare pays for a completed ambulance transport when the patient’s condition requires it. The Medicare Benefit Policy Manual makes the patient’s condition at the time of transport central to coverage.

Medicare pays no separate standby amount for keeping a staffed ambulance available. When several units respond, its transport benefit ordinarily pays only the transporting unit. The completed transport is the event the claim turns into revenue. In a phantom-ride scheme, the paperwork creates that event for payment even though the company never supplied the ride.

When the Billed Ambulance Was a Car or Van

A patient transported in a passenger car can have the trip billed as an ambulance ride. The run sheet then describes a vehicle the driver never used.

In a criminal guilty plea described by the Justice Department, a Brotherly Love Ambulance driver admitted transporting patients in his personal vehicle and a company minivan. Both lacked the lifesaving equipment found in an ambulance. He nevertheless completed ambulance run sheets and signed them. The sheets misstated the patients’ medical conditions and the care provided to make the trips appear to have been ambulance transports.

The false account covered more than the vehicle. It supplied a medical story to go with it. That is why we examine the narrative beside the vehicle assignment and the driver’s account: each describes part of the same trip, and each can expose what the other leaves out.

After Brotherly Love stopped operating, the driver continued writing false run sheets at its successor, VIP Ambulance. The plea account follows the person doing the paperwork across the change in companies. An insider who knows how the records were prepared may recognize the practice even after the name on the business changes.

A Chair-Van Trip Changed on Paper

The whistleblower’s complaint against Medstar Ambulance alleged a similar substitution inside the billing office:

The complaint alleged that a supervisor attributed the changes to management instructions. We want to know who made that change, what the original record said and which claim followed it. We see a very convenient transformation in that allegation: a chair-van on the road, an ambulance in the billing records.

When the Ride Never Happened

When a patient took public transit and an ambulance company billed the ride as its own, the patient’s actual journey supplies the comparison with the claim. VIP Ambulance’s owner admitted this kind of conduct in his guilty plea to false statements, announced in June 2016. He admitted false billings for the purported transport of three patients VIP did not actually transport.

The admitted conduct included completing documentation for ambulance runs that never occurred. Some patients were no longer receiving dialysis. Others took public transportation to the dialysis clinic. The paperwork supplied a company transport where the actual events supplied either a different journey or no dialysis trip at all.

A recurring appointment gives this question particular importance. Dialysis transportation can generate repeated claims, each tied to a service date. In the VIP account, a continuing paper trail concealed that the company’s part in the journey had ended or never happened. A schedule, a completed run report and a paid claim therefore answer different questions. No company vehicle required.

The Run Report Connects the Trip to the Claim

The run report, also called a run sheet or patient care report, records the facts that support the billed ambulance service. Those facts reach beyond the patient’s diagnosis. They include the dispatch instructions, the patient’s condition, the reason another mode of transportation was unsafe, the service provided, the trip times, mileage and destination.

In its 2003 guidance for ambulance suppliers, the HHS Office of Inspector General told suppliers to gather those details and warned personnel against filling gaps through assumptions or inferences. The patient, vehicle, crew and journey have to belong to the same event. A polished narrative can still describe a trip that the people doing the work never made.

Dispatch, Attendance and the Actual Vehicle

Dispatch instructions and trip times connect the report to the work assigned. We compare the scheduled pickup with the vehicle and crew assigned to it, then with the patient’s presence at the destination. For a dialysis claim, the treatment record can help identify whether the appointment occurred. The patient’s or caretaker’s account can identify how the patient arrived.

The actual vehicle identifies who supplied the transportation and what kind it was. The run sheet describes the service the company says it furnished. The claim shows what it asked the government to pay for.

Claims With No Matching Medical Service

The HHS Office of Inspector General’s 2015 claims analysis found that Medicare paid $30 million in the first half of 2012 for ambulance transports whose beneficiaries received no Medicare service at the pickup or drop-off locations, or anywhere else. OIG said those payments may have been inappropriate.

That is the gap an insider can help explain: the claim describes a trip to care, while the medical billing shows no corresponding service. A driver or dispatcher may know where the patient actually went and which vehicle carried them.

A Real EMT’s Name on Fake Records

False crew attribution can make a run report look complete. In a separate criminal guilty plea, an ambulance-company owner admitted that more than 2,000 fake ambulance transport records carried the name of another EMT who had never worked for him.

The EMT was a real person. The invented part was that person’s connection to the operator’s records. We connect the named EMT to the employment and assignment records, the other crew member and the specific transport. A name on the page is itself a claim about who was there.

The Claim Adds Service, Mileage and Location

A Medicare ambulance claim ordinarily carries a service base payment and a separate mileage line. Under the Medicare Claims Processing Manual, payable mileage covers the journey with the patient aboard. Travel to collect the patient and the return to quarters do not supply those loaded miles.

The pickup ZIP code affects geographic payment, while pickup and destination information describe the claimed route. An invented trip can therefore carry an invented route and mileage as well as a false account of care.

The Date Connects the Patient to the Claim

The patient’s condition and transportation on the billed date give a complaint about an ambulance charge its meaning. When a patient or family member says the ambulance never came, we connect the person’s identity, the service date and the claimed ride to dispatch, transport and facility records. That turns a general complaint about a bill into a specific account of a service the company claimed to provide.

Later transportation can also point toward records worth examining. In the government’s complaint against Hart to Heart Transportation Services, the United States alleged that Medicare paid for 419 dialysis trips for one patient. After the company stopped transporting that patient, the patient received 397 dialysis treatments without ambulance transport. For another patient, the complaint described later dialysis attendance without an ambulance and a caretaker who reported driving the patient by car.

Those are allegations about medical necessity. For a claim about a ride never provided, we focus on who transported the patient on the date billed.

A physician certification addresses the need for transportation. The run report describes what happened. In the Hart to Heart complaint, the government also alleged that the company sought missing, newly created or revised certifications for completed transports during its investigation. We examine the original trip account alongside the later paperwork and the instructions behind any change.

What the Billing Office Can Bring to a Whistleblower Case

A billing employee may see the conversion that the driver never sees: a chair-van journey entered as an ambulance run, or a description changed before a claim goes out. Medstar’s case began with a former employee in its billing office. The company settled False Claims Act allegations for $12.7 million, and the whistleblower received approximately $3.5 million. The employee’s position in the billing office put the service description and the payment request in the same person’s hands.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. The driver who knows which vehicle was used and the biller who knows how it was recorded can each supply a different part of that account.

You Know Which Vehicle Made the Trip

If your dispatch records, run sheets or billing work show ambulance claims for rides the company never supplied, speak with our whistleblower experts about the trips you know. We build the case with you and bring in ambulance fraud whistleblower lawyers who understand how the trip becomes a Medicare or Medicaid claim. We stay beside you through the case, keeping the actual trips and the decisions behind the billing at its center.