AmeriCare Ambulance in Tampa: Employee Evidence Behind the BLS Settlement

In the AmeriCare Ambulance Tampa settlement, AmeriCare Ambulance Service and its sister company, AmeriCare ALS, agreed to pay approximately $5.5 million to resolve allegations of billing Medicare and TRICARE for medically unnecessary basic life support, non-emergency transports. A former employee brought the case. If you know what happened on the trip and what the paperwork later said, you can see why an employee’s knowledge mattered. The Justice Department announced the settlement on January 30, 2018.

What the Government Said the Records Showed

The government alleged that AmeriCare submitted false claims from January 2008 through December 2016 for non-emergency ambulance transports that were not medically justified. Its account described a recurring practice supported by thousands of allegedly false reports and other documents. We see the absurdity: the paperwork meant to justify the rides was itself part of the alleged fraud.

The employee evidence reached beyond the person who filed the case. According to the Justice Department, numerous AmeriCare employees supplied information about unwarranted transports. The agencies administering Medicare and TRICARE conducted audits. Investigators also obtained testimony under oath from members of AmeriCare’s management team. The government said those sources, taken together, showed a system of falsely attesting to medical necessity.

An employee can explain what happened inside the operation. An audit can compare the claim with its support. Management testimony can address the decisions behind repeated billing. We look at how those accounts connect: the patient the crew encountered, the description recorded, and the service charged to the government.

Falsified ambulance run reports can turn a crew’s patient-care account into support for an unnecessary claim. The Inspector General’s 2003 guidance for ambulance suppliers identified what the report should record: the patient’s condition, why other transportation was unsuitable, the reason for the service level, who ordered the trip and what care was provided. Dispatch and arrival times, mileage and pickup and destination information connect that account to a particular journey.

When the report and the patient’s condition diverge, the person who saw the patient may know exactly where the story changed. The government’s complaint against Hart to Heart Transportation Services alleged that management and billing staff could alter crews’ patient-care narratives to describe patients who could walk as unable to walk.

What Is Considered Medically Necessary for an Ambulance?

An ambulance is medically necessary under Medicare when the patient’s condition makes other transportation unsafe and requires both the ambulance and the level of service provided. The Medicare Benefit Policy Manual ties the decision to the patient’s condition at the time of transport.

That explains the BLS allegation in AmeriCare’s case. The government challenged whether the patients needed ambulance transportation at all. The question reaches the reason for the ride, before any argument over a higher service level. A report that falsely describes the patient’s need can supply the apparent justification for the whole ambulance claim. For the non-emergency rides at issue here, the manual draws a sharp line: Medicare does not pay for an ambulance when another method could be used safely, even if that alternative is unavailable.

What Is an Ambulance Physician Certification Statement?

An ambulance physician certification statement documents a physician’s certification of the need for ambulance transportation for trips subject to that requirement. Medicare requires it for certain non-emergency transports, including scheduled repetitive trips. A signed statement alone does not establish medical necessity.

We read the physician certification statement alongside the patient-care account. Who signed a form and what the crew observed are different pieces of the payment decision. The signature cannot explain away a description that conflicts with the patient’s actual condition.

The Government First Declined, Then Joined the Case

The former employee brought a qui tam case that the government first declined to join, then took over. The government later filed its own complaint.

Medstar Ambulance supplies a useful comparison. A former billing-office employee carried that case after the United States declined to join, and it reached a settlement. Employee knowledge remained central in both cases, even though the government’s participation differed. The AmeriCare resolution resulted from the coordinated work of the U.S. Attorney’s Office for the Middle District of Florida, HHS-OIG and the Defense Criminal Investigative Service.

What Is a Corporate Integrity Agreement?

A corporate integrity agreement places a provider under compliance obligations overseen by HHS-OIG. AmeriCare agreed to an integrity agreement as part of its resolution, alongside the settlement payment. OIG’s entry for the two AmeriCare companies lists a five-year agreement focused on claims review, now closed.

What Evidence Does a Whistleblower Need?

In an ambulance healthcare fraud case, useful evidence connects the patient’s actual condition with the report, the submitted claim and the decisions behind it. AmeriCare’s case shows how accounts from employees, audits and management testimony can address different parts of that connection.

A crew member may know why the medical description is wrong. A biller may know how that description supported a charge. A facility worker may know the patient’s condition when transportation was arranged. We work with that knowledge to identify the conduct, the claims it affected and who understood the discrepancy.

The Justice Department said the former AmeriCare employee would receive roughly $1.15 million from the settlement proceeds. That was the whistleblower’s share of the recovery. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know the Trip Behind the Claim

If the patient reports or billing instructions at your ambulance company tell a different story from the trips you know, speak to our whistleblower experts about building your strongest ambulance whistleblower case. We build the case with you and bring in ambulance fraud whistleblower lawyers who understand medical-necessity disputes and Medicare billing. From the first conversation through the pursuit of a recovery, we stay on your side of the table.