County Ambulance in Ellsworth: The Excluded-Employee Settlement
In the County Ambulance Ellsworth settlement, the Maine company agreed to pay $16,776 over allegations that Medicare and MaineCare money funded an excluded employee’s salary and benefits. The claims covered January 2015 through April 2016. For someone who sees hiring, screening or reimbursement inside an ambulance business, the payment issue can reach the office as well as the ambulance.
The defendant was County Ambulance Service, Inc., doing business as County Ambulance, Inc., in Ellsworth, Maine. The U.S. Attorney’s Office for the District of Maine announced the civil settlement on July 17, 2018. The agreement called for payment to the United States and the State of Maine. MaineCare is Maine’s Medicaid program. The announcement said the United States paid about two-thirds of all claims submitted to MaineCare. The state program’s name can obscure whose money is at stake. Federal taxpayers fund much of that care, too.
An Excluded Employee on the Payroll
The government alleged that County Ambulance used Medicare and MaineCare reimbursement to pay an employee already excluded from federal health care programs and MaineCare. According to the government’s account, the employee had surrendered a pharmacy-technician license because of diversion of controlled substances before joining the company. The exclusion followed that surrender.
That earlier pharmacy work matters because it explains the exclusion the government said County Ambulance missed. The alleged payment problem arose when the ambulance company used program money for the employee’s salary and benefits.
The government’s explanation of the payment restriction reaches well beyond hands-on care:
Federal health care programs may not pay for items or services furnished, ordered, or prescribed by excluded individuals or entities, including administrative and management services or salary.
An ambulance business has to account for who receives its program-funded pay as well as what it bills for a ride. For an office employee who knows the staffing decisions, that puts familiar work at the center of the allegation.
The Public Check the Government Said Was Missed
County Ambulance allegedly failed to check publicly available exclusion databases to determine whether the employee was excluded. We expect an employer using public healthcare money to check a public exclusion database. Public information. Unchecked.
For an insider, that makes the hiring and payroll history meaningful. The question is how an excluded employee entered the workforce and received pay funded by Medicare and MaineCare. A screening record, an employment date and a payroll entry each describe a different part of that connection. We examine how those parts fit together and what the people making the decisions knew. The U.S. Department of Health and Human Services Office of Inspector General and the Maine Attorney General’s Office investigated the County Ambulance case.
Why Payroll Belongs in the Ambulance Payment Story
Ambulance reimbursement finances a business with substantial staffing costs. Medicare ordinarily pays for a completed transport, while an ambulance service has to keep people and vehicles ready between calls. Payroll continues through the quiet hours.
Minnesota’s Emergency Medical Services Regulatory Board put a scale on that expense in its November 2023 Financial Evaluation of Minnesota’s Ground Ambulance Industry. Roughly 75 percent of reported operational expense was personnel salary and benefits.
The money received for a ride helps support the service between rides. Medicare pays no separate standby amount for keeping a staffed ambulance available through a quiet shift. That is why an ambulance company’s finances cannot be understood from the billed trip alone: the service has ongoing expenses even when no patient is aboard.
In County Ambulance’s case, the government alleged that program receipts went toward an excluded employee’s compensation. The operational link between revenue and wages is ordinary ambulance business. Who received those wages was the issue here.
Excluded Employees in Other Ambulance Settlements
Excluded-employee allegations have also appeared in civil settlements with the Office of Inspector General involving County of Wilson EMS in North Carolina and Acadian Ambulance Service of Texas. Both matters followed provider self-disclosures. Their common feature with County Ambulance is the employment of an excluded person, which gives an insider a reason to look at the workforce and payment relationship.
The Maine medical-necessity cases concern a different part of the business. North East Mobile Health Services and Maine Medical Center reached separate settlements over allegations that North East falsely described patients as bed-confined or otherwise needing ambulance transportation, and that hospital personnel supplied incomplete or inaccurate medical-necessity statements used to bill Medicare. Capital Ambulance settled allegations that it used certification statements containing incomplete or incorrect information for non-emergency transports of patients discharged from Eastern Maine Medical Center. These allegations put the patient’s condition and the hospital’s paperwork at the center of the case. County Ambulance’s case puts the focus on the people receiving program-funded pay.
What Evidence Is Needed to Report Fraud?
For an excluded-employee payroll allegation, the useful connection is between the employee’s exclusion, employment, compensation and the government-program money used to pay it. Hiring and screening information can explain how the employee entered the business. Salary and benefit records can explain the compensation, while reimbursement records connect it to Medicare or Medicaid funds.
You may see that connection from human resources, payroll, billing or management. Our whistleblower experts work through what you know with you and identify the expertise the case needs. If your knowledge concerns the hiring decision, we start there. If you work with pay or reimbursement, we start with what that work lets you see. You can speak with us about your part of the business, and we will work through how it connects to the alleged conduct. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.
You See Who Gets Paid
If your work gives you a view of an excluded employee’s pay and the Medicare or Medicaid receipts behind it, speak with our whistleblower experts about who was paid and with whose money. We build your strongest ambulance fraud whistleblower case around the employment and payment decisions, bring in ambulance fraud whistleblower lawyers who understand exclusion issues, and remain your partners as the case moves forward.
