Unicare Ambulance: Medicare Debts and the Ownership Story

In the Unicare Ambulance Pennsylvania judgment, two ambulance companies and their owners agreed to pay $459,907 to resolve allegations that they made repeated false statements to avoid Medicare overpayment debts and hide an owner’s licensing history. The Justice Department’s account went further: the government alleged that Unicare kept providing ambulance services and billing Medicare after Pennsylvania revoked its ambulance license. For someone who handled the claims or ownership paperwork, that is the part of the story to recognize.

The companies were Unicare Ambulance LLC and PA Paramedics LLC, doing business as EasternCare Ambulance, based in Bensalem, Pennsylvania, in Bucks County. The U.S. Attorney’s Office for the Eastern District of Pennsylvania announced the agreement on July 9, 2019.

False Statements to Avoid Medicare Overpayment Debts

The government alleged that the defendants made repeated false statements to state and federal officials from September 2015 through August 2016. According to the Justice Department’s description of the complaint, those statements served two purposes: avoiding Medicare overpayment debts and hiding an owner’s suspended paramedic license.

That puts the company’s identity inside the billing story. Medicare had an overpayment debt to pursue, and the government alleged that false information stood between the program and repayment. The relevant paperwork extended beyond the original transport claim to what the businesses told the authorities about themselves.

The U.S. Attorney explained why ownership disclosures matter:

In the government’s account, the business wanted Medicare to pay its bills while using false ownership information to dodge its own debt. We see the same taxpayers on both sides of that demand.

The Owners’ Different Records

The Owner’s Paramedic License and Physician-Signature History

The Justice Department reported that one owner’s state paramedic license had previously been suspended because he admitted forging a physician’s signature. The government alleged that the defendants’ later statements concealed that history.

The Inspector General’s exclusion notice records that this owner agreed to a ten-year exclusion from all federal health care programs. His personal license history explains why the government’s account reaches beyond the amount Medicare wanted repaid: regulators were also being told who was behind the ambulance operation.

For an employee familiar with management, the connection may be visible in ordinary work. We examine what the ownership disclosures said alongside what the insider knows about the people directing the business. In this case, the alleged concealment concerned a specific owner’s licensing history.

The Co-Owner’s Statements and Separate Exclusion

The other owner, described by the Justice Department as his former wife, was also a party to the shared judgment. The government included her in the allegation that the defendants individually or collectively made repeated false statements to avoid Medicare debts and conceal the suspended license.

She agreed to a five-year exclusion from federal healthcare programs. Her part of the announced case concerned the shared alleged statements and debt avoidance. An insider can explain who supplied information, who approved it and who knew the history behind it.

Unicare’s Ambulance License and Medicare Billing

The Pennsylvania Department of Health revoked Unicare’s ambulance license after learning the concealed history, according to the Justice Department’s account. The government alleged that Unicare nevertheless continued providing ambulance services, billing Medicare, making false ownership statements and retaining the reimbursement funds it had obtained through fraud.

An ambulance license revoked. Unicare still billed Medicare, according to the government.

For a biller, that allegation connects a business-level decision to individual claims. We would compare the license notice with the service dates, the claims submitted afterward and the instructions reaching the billing office. An ownership statement and a paid transport claim can describe the same operation from very different directions.

The Centers for Medicare & Medicaid Services, its local Medicare contractor Novitas Solutions, Inc., and the Department of Health and Human Services Office of the General Counsel first detected the suspicious activity. In early 2018, the CMS Center for Program Integrity revoked Unicare’s Medicare enrollment for three years and suspended pending Medicare payments for services before that revocation.

PA Paramedics and the Shared Judgment

PA Paramedics, operating as EasternCare Ambulance, joined Unicare and the owners in the agreed judgment. The monetary obligation was shared across all four defendants.

The Inspector General recorded the voluntary exclusion agreements on July 8, 2019, in connection with the resolution of False Claims Act liability. Unicare and PA Paramedics each agreed to five years outside all federal health care programs.

The government’s allegation reached both businesses and both people, while the announced licensing and Medicare enrollment revocations concerned Unicare. An employee who worked under the EasternCare name may recognize a different part of the same case from someone who handled Unicare’s claims.

What the Ambulance Records Can Show

Unicare’s alleged concealment reached beyond the patient record to the business submitting the bill. A billing office handles both accounts: what justified the ride and who was entitled to bill for it. The Medicare Benefit Policy Manual ties medical necessity to the patient’s condition at the time of transport.

An ambulance physician certification statement supports the medical account. A signature alone cannot establish that the ride was medically necessary. In dialysis ambulance billing, the same distinction applies to recurring trips: the patient’s condition still has to support the transport.

The difference between a crew’s observation and the version used for billing is central to falsified ambulance run reports. A separate whistleblower complaint against First Call Ambulance Service described an instruction inside the billing office:

The alleged instruction called for describing a patient who walked into the ambulance as bed-confined. The person who knows the original report can explain what the version used for billing leaves out.

For Unicare’s alleged debt avoidance, we would also examine the overpayment correspondence, ownership disclosures and licensing records. Those documents address what the company told regulators after questions arose about its right to keep the money or continue billing. An accurate patient record does not answer who was behind the business or what it told Medicare about its debts.

Overpayments and the Decisions That Follow

Other ambulance cases show how the response to an overpayment becomes part of the alleged fraud. In the North East Mobile Health Services settlement, the government alleged both false claims about patients’ bed confinement or medical need and knowing retention of Medicare overpayments.

In the Tri-Med Ambulance enforcement action, the government alleged that the company submitted duplicate claims, identified the resulting overpayments and failed to return them promptly. Unicare’s case adds the alleged use of false statements to escape the debt. The common question is what the business knew about money it had already received and what it did next.

That is where an insider’s knowledge can connect the correspondence to a decision. A person who handled a regulator’s question may know who prepared the answer. A billing employee may know whether claims continued after a license notice arrived. We work with that account to understand the conduct, the records supporting it and the people responsible for the decisions. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Who Was Behind the Billing

If you handled ownership disclosures, Medicare debt correspondence or claims submitted after a license revocation, speak to one of our Whistleblower Experts about what you saw. We work beside you to build your strongest Medicare whistleblower case around those decisions and bring in Medicare fraud whistleblower lawyers who understand ambulance billing and provider enrollment. We stay with you through the case, including the questions that make speaking up difficult.