Andres Medical Billing: The Kurtz Ambulance Emergency-Rate Settlement

In the Andres Medical Billing Kurtz settlement, the companies agreed to pay $77,543 to resolve allegations that Andres submitted Medicare claims at the BLS emergency rate when the transports qualified only for the lower non-emergency rate. The allegation concerns a decision a billing employee may recognize: whether the code sent to Medicare matched the response the trip required. Both the ambulance operator and its outside biller entered the settlement.

The Illinois companies reached the agreement with the Department of Health and Human Services Office of Inspector General on February 9, 2016. The inspector general’s enforcement notice identifies Andres Medical Billing, Ltd. as the third-party biller for Kurtz Ambulance Service and attributes the disputed claim submissions to Andres.

What BLS Emergency Meant on the Claim

BLS emergency billing combines a service level with a response classification. Basic life support describes the ground ambulance service, its medically necessary supplies and services, and its required crew. Emergency describes the response to the call.

The billing codes make the distinction visible: A0428 identifies BLS non-emergency service, while A0429 identifies BLS emergency service. In the Andres settlement, the Office of Inspector General alleged that the emergency designation carried a higher rate than the transports qualified for. Billing BLS care as advanced life support changes the service level on the claim, rather than its emergency classification.

Under Medicare’s ambulance coverage guidance, emergency classification turns on the nature of the call at dispatch and an immediate response. A call directly to the ambulance company can qualify when dispatch meets the local emergency system’s standards.

When dispatch does not meet those standards, Medicare looks to the patient’s condition at the scene to determine the payment level. For a billing insider, that directs attention to the call and response behind the emergency code: what was reported, how dispatch classified it, and what the crew found.

We see the absurdity in the allegation: the billing code claimed an emergency the trip did not justify. A higher rate, without the response to support it.

Does Medicare Pay for Non-Emergency Ambulance Transportation?

Yes. Medicare can pay for non-emergency ambulance transportation when the patient’s condition requires an ambulance and the applicable coverage and documentation requirements are met. The patient must need both the ambulance transportation and the level of service billed, with a covered origin and destination.

That explains the lower rate in the Andres allegation. The inspector general’s office alleged that Andres should have billed the claims as non-emergency transports.

A signed physician certification also answers a different question from the dispatch record. It can support the need for transportation, but the signature alone does not establish medical necessity.

Where the Operator’s Records and the Biller’s Code Meet

The operator’s records describe the trip. The billing operation turns that account into a request for payment. In this case, the Office of Inspector General placed the submission of the allegedly overstated emergency claims with Andres, acting for Kurtz.

The crew’s patient care report, also called a run report, records the patient’s condition and the services provided. The Office of Inspector General’s ambulance guidance, published in 2003, called for the service level, dispatch and arrival times, and why the patient needed an ambulance. It also told staff not to fill missing information by assumption or inference.

Those details let us compare the account of the transport with the classification that reached Medicare. The dispatcher may know why the call received an emergency response. The crew may know what the patient needed. The billing employee may know which code was selected, whether it changed, and whose instruction controlled the submission.

For an outsourced health care billing operation, the handoff matters as much as the final code. We examine what information came from the ambulance company, what the billing office used, and whether a later revision changed the account supporting payment. That connects the service to the submission and the people making the decisions, instead of treating the code as the whole story.

When Billing Staff Can Change the Patient’s Story

A separate case involving Hart to Heart Transportation Services and its billing affiliate, EMS Billing Solutions, shows why access to clinical records matters. The government’s complaint alleged that management and billing personnel could change the crew’s account when the crew would not:

That allegation concerns changes to the patient care report itself. The government also alleged that managers instructed billers to choose payable catchall diagnosis codes when the documentation did not specify a billable diagnosis. The complaint described a billing process that could change both the account of the patient and the code used to seek payment.

A former employee brought that whistleblower case, and the government later joined it. Hart to Heart and EMS Billing Solutions reached a settlement resolving the allegations in 2019. Taken together, the Andres and Hart to Heart allegations show different decisions inside a billing operation: sending an emergency claim, selecting a diagnosis, or changing the clinical narrative that supports it. Each decision has its own records and people who can explain it.

What Evidence Does a Whistleblower Need?

We connect the dispatch decision and the crew’s account to the code actually submitted. We examine the call information, the applicable dispatch protocol, the run report and the Medicare claim together. Where an instruction or edit changed the classification, we examine that decision alongside the original information.

Someone in billing may recognize a repeated instruction to use the emergency designation, or a code change that conflicts with the transport account. Someone at the ambulance company may understand the dispatch record but never see the final claim. Our work is to connect what each person knows to the payment Medicare was asked to make.

The Andres and Kurtz agreement puts that work in focus. The inspector general’s office named the outside biller as the company submitting the disputed claims, and both companies settled. An employee who understands the handoff between operator and biller can explain a part of a healthcare fraud case that the final claim alone cannot show. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know How the Claim Reached Medicare

If you saw emergency codes selected against the dispatch record or clinical accounts changed to support payment, talk with our whistleblower experts about what happened in your billing operation. We build your strongest ambulance fraud whistleblower case around the decisions you witnessed. We bring in ambulance fraud whistleblower lawyers who understand outsourced Medicare billing and stay beside you as the case develops.