Hart to Heart Ambulance: The Hospital-Discharge False Claims Settlement

In the Hart to Heart ambulance settlement, Hart to Heart Ambulance Services agreed to pay $1,250,000 to resolve allegations that it billed Medicare for medically unnecessary, non-emergency hospital-discharge transports. The government described pressure on crews to produce false patient-care reports that made reimbursement more likely. For an EMT who saw the patient or a biller who saw the report change, the case reaches a familiar question: whose version of the patient’s condition became the Medicare claim?

What Hart to Heart Settled

Hart to Heart settled allegations involving non-emergency basic life support hospital discharges from January 2, 2010 through December 31, 2017, according to the Justice Department’s June 20, 2019 announcement. A former Hart to Heart employee brought the False Claims Act qui tam case. The U.S. Attorney’s Office for the District of Maryland handled the government’s case, and the Department of Health and Human Services Office of Inspector General investigated. The government later filed its own complaint against Hart to Heart, its billing affiliate EMS Billing Solutions, Inc., and the organizations’ owners and operators.

The $1,250,000 hospital-discharge settlement was a fraction of the $32.9 million in Medicare payments the government’s complaint reported for Hart to Heart’s wider basic life support non-emergency transport business, including mileage, from 2010 through 2017. At issue was whether the patient’s condition justified an ambulance and whether the account sent toward Medicare described that condition honestly.

What Is Considered Medically Necessary for an Ambulance?

An ambulance is medically necessary when the patient’s condition makes other transportation unsafe. The condition must justify both the ambulance itself and the level of service provided.

In Hart to Heart’s case, the government alleged that the company submitted a high rate of ambulance claims for patients who could have traveled by wheelchair van or other means. That is why the patient’s ability to sit, stand or walk mattered to the alleged billing scheme.

The Medicare Benefit Policy Manual makes the comparison practical: if another method could carry the patient without endangering their health, Medicare does not pay for an ambulance even when that alternative is unavailable. Bed confinement is one part of the patient’s condition to consider. The manual requires the whole condition to support the need for ambulance transportation.

For a hospital discharge, that puts the crew’s actual observations at the center of the payment question. The government alleged that Hart to Heart’s instructions worked backward from the payment it wanted.

What Is an Example of Improper Documentation on a Patient Care Report?

The Hart to Heart complaint alleged that crews recorded a staged bedside encounter while leaving out their first observation of the patient. The government described a policy for patients whom crews found sitting, standing or walking:

United States’ complaint against Hart to Heart Transportation Services, Inc., paragraph 68

We see the absurdity in asking a crew to forget what it just saw so the bill has a better chance of being paid. Other allegations described the same aim through different instructions. The complaint said crews were told to document a two-person lift and maximum assistance even when that assistance had not occurred or was unnecessary. It also described a punch-clock memo directing crews to prevent stretcher patients from walking and leave their ability to walk out of the report.

The paperwork would then carry a more dependent patient than the crew had encountered, according to the government’s allegations. That gap is something a crew member can recognize from the ride itself.

EMS Billing Solutions and the Medicare Claim

EMS Billing Solutions was Hart to Heart’s billing affiliate and a named defendant in the government’s complaint. The allegations reach into the billing office as well as the ambulance: management and billing personnel could access crew narratives and falsify them when crews refused, including changing an ambulatory patient into a non-ambulatory one on paper.

The complaint also alleged that managers instructed EMS billers to select Medicare-payable catchall diagnosis codes when the patient’s documentation did not specify a billable diagnosis. A former billing clerk described selecting “fall risk” for patients who used a wheelchair or walker, however thin the supporting documentation. According to the complaint, EMS then billed those claims to Medicare and pursued denied claims on appeal.

The Certification Requested After the Ride

The government alleged that Hart to Heart sought missing, new or revised physician certification statements for rides Medicare had already paid. Its complaint described letters and emails to Bayhealth employees requesting documentation to support ambulance trips months or years earlier.

A signature on the form does not make the ride necessary. The patient’s condition remains the test. That is why a certification, the crew narrative and the claim matter together: they describe the medical justification for the same ride, from different places in the health care operation.

For a hospital employee receiving such a request, the meaningful question is what the new document was being asked to say about the earlier encounter. We connect that account with what the crew recorded and what billing submitted.

The Patient Outside the Billing Narrative

The complaint compared Hart to Heart’s billing with accounts of the same patients elsewhere. In one hospital-discharge example, Hart to Heart sent a transport to Lifestar Response Corporation. The government alleged that Lifestar transported the patient but refused to bill Medicare because the patient was ambulatory, billing Hart to Heart instead. Medicare and taxpayers bear the cost when a patient’s mobility disappears from the bill.

The government’s complaint also described repeated dialysis trips beyond the hospital-discharge allegations resolved in the announcement. It alleged that one patient continued to receive 397 dialysis treatments without ambulance transportation after Hart to Heart stopped transporting the patient.

The government’s complaint described a separate dialysis patient for whom Medicare paid Hart to Heart about $26,295 for 134 trips between July 14 and December 31, 2015. It alleged that neither Hart to Heart nor another ambulance provider transported that patient to or from dialysis after prior authorization took effect on January 1, 2016, yet the patient received 388 dialysis treatments between January 3, 2016 and September 21, 2018.

The patient’s caretaker reported driving the patient to dialysis in a car and said the patient had used a rolling walker for several years, after previously walking without assistance. That separate history appears in paragraph 111 of the government’s complaint. It concerns dialysis claims beyond the hospital-discharge allegations resolved in the settlement announcement; later travel alone does not establish the patient’s condition on every earlier ride.

The government also reviewed the documentation itself. In a sample of 45 basic life support non-emergency transports from 2011 through 2012, its reviewer found approximately 55% medically unnecessary, according to the complaint.

The Whistleblower’s Case After the Government Declined

The United States first declined to join the whistleblower’s case, then filed its own complaint, as the District of Maryland docket records. The same reversal occurred in AmeriCare Ambulance’s case, settled in 2018: the United States initially declined, then joined the whistleblower’s case. A first no was not the last word.

Hart to Heart’s settlement announcement allocated the whistleblower a reward of about 20% of the settlement. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

What Evidence Does a Whistleblower Need?

Connecting the patient’s condition to the report, the certification, the billing decision and the Medicare claim is the work we do with you. The complaint identifies each of those connections through employee accounts, report access, diagnosis choices, certification requests and patient comparisons.

A crew member may know which observation disappeared. A biller may know who selected the diagnosis or changed the narrative. A hospital employee may know what a later certification request asked them to confirm. Those are different views of the same payment, and we work with the person who holds each view to establish how the decisions fit together.

The alleged instruction matters as much as the altered wording. In this case, the government described management directing changes to make reimbursement more likely. For a healthcare insider, knowing who asked for the change and what the original report said can explain how a clinical account became a false billing justification.

You Saw the Patient Before the Report Changed

If your crew report, billing screen or certification request told a different story from the patient you knew, tell our whistleblower experts where the account changed. We build the case with you and bring in ambulance fraud whistleblower lawyers who understand how clinical documentation becomes a Medicare claim. We stay with you from that first conversation through the pursuit of a recovery.