Century Ambulance Service: The Discharge Papers Behind the Ambulance Bill

The Century Ambulance settlement required Century Ambulance Service to pay $1.25 million to resolve allegations of upcoding and unnecessary ambulance transports, including unnecessary trips home handled as emergencies. For someone working a hospital discharge desk, riding with the crew or preparing the bill, the case follows familiar paperwork: a hospital certifies the need for an ambulance, the crew records the trip, and the supplier submits the claim. The government’s allegations reached both the hospital and the ambulance company.

The Justice Department’s May 8, 2015 announcement described a $7.5 million Jacksonville resolution involving nine hospitals and Century. The hospital defendants included Baptist Health’s hospitals and UF Health Jacksonville. Century’s payment was its own part of that package. The hospitals settled the allegations about their certifications separately.

Three Billing Allegations Against Century

The government alleged that Century misrepresented the service level and provided unnecessary transportation from January 1, 2009 through April 2014. Its announcement separated the ambulance company’s conduct into three allegations:

1. Basic Life Support Upcoded to Advanced Life Support. Century allegedly submitted claims at the advanced life support level when the service belonged at the basic level.
2. Unnecessary Ambulance Transports. Century allegedly transported patients who did not need ambulance transportation.
3. Unnecessary Emergency Trips Home. Century allegedly transported patients to their homes in an emergency fashion when that was unnecessary.

Those allegations reach different parts of the bill. One concerns the level of care claimed, another the need for an ambulance at all, and another the emergency treatment of a trip home. A description of the patient’s condition has to support the claim that follows it.

The settlement concerned healthcare claims submitted to Medicare, TRICARE, Medicaid and the Federal Employees Health Benefits Program. The case began with a whistleblower’s qui tam lawsuit under the False Claims Act.

What Is Considered Medically Necessary for an Ambulance?

An ambulance is medically necessary under Medicare’s coverage standard when the patient’s condition makes another means of transportation unsafe and requires the level of ambulance service provided. The patient must need both the ride and the care billed for it.

The Medicare Benefit Policy Manual makes the comparison concrete. If another method could carry the patient without endangering the patient’s health, Medicare does not pay for the ambulance, even when that other transportation is unavailable. A hospital’s difficulty arranging a ride home does not change the patient’s medical condition.

This is why the discharge setting matters. The hospital needs to move a patient, but the ambulance claim represents a medical need for a particular form of transport. We see the absurdity in treating a signature as the answer to a clinical question when the government says the certified rides were unnecessary.

Does Medicare Pay for Non-Emergency Ambulance Transportation?

Medicare covers medically necessary non-emergency ambulance transportation. In Century’s case, the government challenged whether the patients needed the transportation and the service claimed. The allegation reaches the clinical basis for the bill, beyond whether a hospital requested a ride. That medical-necessity requirement also governs recurring ambulance rides to dialysis, where the appointment itself does not establish a need for an ambulance.

What Is an Ambulance Physician Certification Statement?

An ambulance physician certification statement certifies the medical need for transportation and helps support the supplier’s claim. The signature alone does not establish that the ride was medically necessary.

In Jacksonville, the government alleged that hospital staff provided Certificates of Medical Necessity attesting to the need for basic life support, non-emergency transports even when the rides were unnecessary. That was the hospital-side allegation. Century faced the separate allegations about its transport and billing practices.

The handoff gives hospital employees a view that an ambulance biller may never have. The hospital supplies information about the patient’s condition and the requested transport. The crew sees the patient during the trip. The billing office turns the documentation into a claim.

The coverage regulation expressly says a certification does not alone demonstrate medical necessity. The patient’s medical record and the transport documentation still matter. For a hospital insider, the connection to a federal health care payment can begin with the certificate the hospital supplies, even though the ambulance company sends the bill.

The Department of Health and Human Services Office of Inspector General had already identified unnecessary transports and basic-to-advanced life support upcoding as risks in its 2003 ambulance compliance guidance. It also told suppliers to document the patient’s condition at transport and the reason for selecting the service level.

What Does ALS Mean on an Ambulance Bill?

ALS means advanced life support. At the ALS1 level, Medicare’s definition includes ground transportation, medically necessary supplies and services, and either a qualifying ALS assessment or an ALS intervention.

The assessment matters. It is an assessment by an ALS crew during an emergency response, needed because the condition reported at dispatch required that crew’s skills. The dispatch information and the crew’s work therefore belong alongside the code when explaining a bill.

The Centers for Medicare & Medicaid Services bases payment on the medically necessary service furnished. Sending an ALS-equipped vehicle does not supply the clinical reason for an ALS claim. Century’s alleged basic-to-advanced upcoding concerned that relationship between the service and the claim.

Emergency Billing Starts With the Call

Emergency response is a separate question from the level of life support. Both basic and advanced life support have emergency service categories. Medicare’s manual looks to the nature of the call at dispatch and the applicable emergency dispatch protocol.

That distinction helps explain the allegation about Century’s trips home. The hospital’s request, the dispatch decision, the patient’s condition and the service furnished each have a place in the account of the trip. An emergency designation cannot establish medical necessity on its own. A discharge billed as an emergency deserves a comparison of those records, beginning with what prompted the call.

The Separate Liberty Case

The same whistleblower brought separate qui tam cases against Century and Liberty Ambulance. The government joined Century’s case for settlement. Liberty later agreed to pay $1.2 million in its separate settlement, announced in 2018.

Emergency Discharge Billing Beyond Jacksonville

At Navicent Health, the HHS Inspector General also identified emergency ambulance billing for hospital discharges to skilled nursing facilities and patients’ homes for investigation. Century’s alleged unnecessary emergency trips home likewise called for comparing the discharge with the service billed.

What Evidence Does a Whistleblower Need?

An ambulance whistleblower’s evidence connects the patient’s condition and the service provided to what the government was billed. In a discharge case, the important connections run through the hospital certification, dispatch information, crew report and claim.

A hospital employee may know how the certification was completed. A crew member may recognize a patient care report that describes services the crew never provided. A biller may know how the report became an advanced or emergency claim. We work with insiders to connect that knowledge to the decisions behind the billing and build the case with whistleblower lawyers who understand ambulance reimbursement.

What Is the Reward for Uncovering Fraud?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. In the Jacksonville announcement, the Justice Department said the whistleblower would collect more than $1.2 million from the settlements. That announced reward covered the combined resolutions with Century and the hospitals.

Your View of the Discharge and the Bill

If you know how a patient’s trip home became an unsupported ambulance claim, speak with our Whistleblower Experts about how that trip was billed. We bring your knowledge of the discharge, the crew’s work and the billing decisions together with ambulance fraud whistleblower lawyers to build your strongest case. We stay beside you as partners through the case, starting with the part of the trip you know firsthand.