River Valley Transport / Med-Alert EMS: A Minivan Billed as Advanced Life Support

In the River Valley Transport / Med Alert EMS fraud case, the owner was responsible for $601,000 in fraudulent claims to Medicare and Texas Medicaid, according to the announcement of his guilty plea. He admitted billing for ambulance services that were never provided and forging EMT signatures. An EMT whose signature appeared on a trip they never worked would recognize the problem immediately: the paperwork put them somewhere they had never been.

River Valley Transport operated as Med-Alert EMS in the McAllen area of Texas. In its February 3, 2015 announcement of the owner’s guilty plea, the U.S. Attorney’s Office for the Southern District of Texas described how he created false documents and submitted false transportation claims. The Department of Health and Human Services Office of Inspector General and the Texas Attorney General’s Medicaid Fraud Control Unit investigated the case.

Forged EMT Signatures

In his guilty plea, the owner described false crew records used to support ambulance claims. He admitted creating documents, or having others create them, to make it appear that a particular emergency medical technician had transported a patient when that technician had not. He also admitted forging EMT signatures or causing others to forge them without authorization.

We see the same basic deception in both parts of this case: the claim borrows the credibility of an ambulance and its crew while the actual trip tells a different story. Medicare and Texas Medicaid paid for false claims backed by that paperwork.

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

A forged EMT signature that makes a technician appear to have participated in a transport is a concrete example. The River Valley owner’s admission concerned documents created to make fraudulent claims look legitimate, including false statements about who had transported the patient.

The broader mechanism is falsified ambulance run reports. A run report, also called a trip sheet or patient care report, carries the crew’s account into billing. It records the patient’s condition, the services provided and the facts used to justify the claim.

An ambulance physician certification statement addresses whether the patient needed ambulance transportation. The technician’s participation, the patient’s need for an ambulance and the service billed all have to connect to the same encounter.

Private-Vehicle Trips Billed as Advanced Life Support

The owner admitted transporting patients in a private minivan, billing those rides as ambulance services and also billing at the higher-paying advanced life support level. Advanced life support appeared on the bill. A minivan carried the patient.

Medicare’s ambulance vehicle requirements explain why the vehicle matters. An ambulance must be designed and equipped for medical emergencies and capable of transporting patients with acute conditions on non-emergency trips.

The payment also depends on what service the patient needed and actually received. The Medicare manual ties payment to medically necessary services actually furnished.

Dialysis Trips That Never Happened

The owner also admitted billing for transportation to and from dialysis clinics on dates when patients received no dialysis treatment and did not even go to the clinics. That is a particularly direct form of dialysis ambulance fraud. Recurring treatment creates recurring transportation business. Each claimed trip still has its own patient, date, destination and account of what happened. A familiar name on a recurring schedule cannot supply the missing visit.

Medicare’s ambulance benefit pays for transportation, and its coverage rules tie the trip to a covered medical service. The patient’s condition must also make another means of transportation medically inadvisable. Here, the owner’s admission about missed clinic visits gets to an earlier question: was there a trip to treatment at all? A clinic employee’s knowledge of whether a patient arrived can matter as much as the ambulance company’s account of the journey.

The whistleblower’s complaint against Lifecare Medical Transports alleged a similar way of manufacturing trips on paper. It alleged extra claims for recurring dialysis patients and described the instruction behind the reports:

The alleged backdating shows why the date a report describes and the circumstances in which someone created it can tell different stories. In River Valley, the owner admitted that false documents were intended to make false claims appear legitimate.

The Former Biller’s Separate Indictment

The October 23, 2013 indictment announcement described charges against River Valley’s owner and a former biller who owned RioPlex Billing Solution. The indictment alleged that the biller helped submit false claims for Med-Alert EMS and participated in the misuse of a patient’s identity.

The indictment alleged approximately 1,524 false claims totaling approximately $638,090 from June 2007 through February 2011 for dialysis patients who had not been transported by ambulance as billed. It alleged that Medicare and Texas Medicaid paid more than $335,000 on those claims. The indictment also alleged phony transportation records and forged signatures used to conceal the conduct.

The conduct reaches different desks: arranging the transportation, creating the report and sending the claim for payment. The biller’s alleged role places the billing operation inside the story, beyond what happened in the vehicle. The transport owner’s later guilty-plea announcement described how a patient’s identity entered the billing: he used, or caused others to use, a patient’s Medicare number to submit false claims to Medicare and Texas Medicaid.

What Evidence Is Needed to Report Fraud?

For a false-transport case, the useful evidence connects the actual ride with the report, the signature and the claim submitted for payment. We look at what each person knew about that encounter and how a different account reached Medicare or Medicaid.

The EMT may know which vehicle carried the patient, who was on the crew and whether the signature is theirs. The biller may know which report supported the claim and who directed a change. The dialysis employee may know whether the patient came to treatment. We connect those accounts to the same claimed transport, including instructions to create a report after the fact or describe care the crew never provided.

The whistleblowers’ complaint against First Call Ambulance Service alleged that billing personnel sometimes changed run reports themselves. One former billing employee described a report showing that a patient had walked into an ambulance, followed by an instruction to change it to say the patient was bed-confined. That allegation shows another point where the patient’s story can change after the crew has written it down.

An EMT can recognize a false account of healthcare without handling the final bill. A billing employee can recognize an instruction to replace the crew’s account without having ridden in the vehicle. Neither perspective has to explain the whole operation before a conversation with us can begin.

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. For someone inside an ambulance company or health care billing operation, the starting point is what they know about the difference between the transport and the claim.

You Know Who Was on the Trip

If you saw a minivan ride become an ambulance claim, a missed dialysis visit become a billed trip or your signature appear on someone else’s account, speak to one of our whistleblower experts about how that trip was billed. We work beside you to build the case around the actual transport, the false record and the decisions behind the billing, and bring in ambulance fraud whistleblower lawyers who understand that chain. We stay with you through the case.