A team of brothers based out of Houston, Texas were recently found to have committed multiple counts of fraud by using their healthcare company to submit over $6 million in false claims to Medicare, Medicaid, and TRICARE. The pair billed the three government programs for services that were not provided, utilizing fraudulent certifications from physicians whom they bribed in order to facilitate reimbursements.
The two owned and operated KMD Healthcare Services, a company whose main purpose was to provide emergency transportation to and from various medical facilities in the area. Knowing that Medicare, Medicaid, and TRICARE would only reimburse them for medically necessary trips, primarily those responding to true emergencies or provided to patients who could not be safely transported otherwise, they bribed a Houston physician $500 for each falsified certification that misrepresented the validity of the ride. They also encouraged their employed EMTs to write up “run sheets” which claimed that services were provided when they, in fact, were not.
During the investigation, it was discovered that not only were these fraudulent claims being made, but the ambulance rides that truly were provided did not meet federal requirements for such services. For example, they would transport patients in a personal van that was purchased through the company and would frequently accompany the riders with only one emergency medical technician, though Medicare standards require at least two. Furthermore, the beneficiaries for whom services were provided were typically ambulatory and in no way necessitated ambulance rides. In one stunning instance, KMD billed Medicare $51,952 for a trip when the patient was found to have walked herself to the appointment.
The fraud became apparent when looking at KMD’s statistics against the state averages. For instance, although they only had 24 patients – ranking them at an astonishingly low 340 out of 374 ambulance providers in the state – they alleged to have provided 1,142 services per patient, whereas the remainder of emergent transport services only provided an average of 110. Equally as startling, Medicare paid over ten times in reimbursements per patient: though the state average was $2,277, KMD was receiving $22.3K for each rider. Altogether, the pair billed an approximated $6,293,108 in false claims to Medicare, Texas Medicaid and Tricare.
Whistleblower Justice Network Can Help You
Whistleblower Justice Network partners with whistleblowers to bring those who knowingly commit fraud to justice. Under the qui tam provisions of the False Claims Act, we assist individuals who bring forth information about fraudulent schemes in filing cases against those who seek to steal from the healthcare system for personal gain.
If you have meaningful information regarding ambulance fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.