Last year Medicare paid more than $50 million in potentially improper bills from ambulance companies. These potential improper bills regarded ambulance rides for older Americans.
According to a report by the Inspector General, one in five ambulance services, which were billing Medicare, had some type of problematic bill. This is one in five ambulances out of nearly 16,000. Because of these numbers, the U.S. Department of Health and Human Services (HHS) announced last year that the Center for Medicare and Medicaid Services is pursuing a new strategy to combat this ambulance transport fraud. This new strategy has already been implemented and is making a difference in Pennsylvania.
Under Medicare, ambulance rides are covered when (1) other kinds of transportation would endanger the patient’s health and (2) when the patient is traveling to and from medical facilities. Ambulance transport fraud occurs when an ambulance company transports a patient who could have otherwise traveled safely to the medical facility themselves, or at least without the aid of an ambulance, and then falsifies the reports to make it appear that the patient medically needed to be transported by ambulance.
In the last couple of years, the government has been targeting ambulance transport fraud. An effective strategy, which has been implemented in Philadelphia, is new ambulance companies are not allowed to be paid by Medicare, and all repetitive nonemergency trips must receive prior authorization before the trip will be authorized by Medicare.
This strategy not only deters the fraud by requiring prior authorization, it also prohibits new companies from being developed for the sole purpose of defrauding the government. Many ambulance companies, when shut down by the government, start back up under a new name. This new rule disallows that from happening.
For example, Bassem Kuran, a driver for Brotherly Love Ambulance Inc., is to be arraigned this month for his activities with VIP Ambulance Inc., a company he started when the government closed Brotherly Love Ambulance Inc. due to Medicare fraud allegations. Kuran has allegedly been defrauding the government through ambulance transit fraud. One allegation is Kuran billed Medicare for transporting a patient for dialysis who did not even need dialysis. Transporting a single patient for dialysis for a year could equal $67,000 in revenue from billing Medicare.
According to Pennsylvania Department of Health data, 83 ambulance companies have closed since early 2014. Since this new program has been implemented in three states (Pennsylvania, New Jersey and South Carolina), the average monthly Medicare cost, in the aggregate for those three states, for scheduled, repetitive ambulance trips has plunged from $18.9 million to $5.4 million.
The qui tam provision of the False Claims Act (FCA) allows private individuals to file lawsuits on behalf of the government when those individuals have knowledge of a person or company defrauding the government. Therefore, private citizens can aide the government in stamping out ambulance transport fraud. The FCA provides monetary incentives for these private individuals, known as whistleblowers, which include 15 to 30 percent of the damages recovered.
Are you aware of fraud being committed against the federal Government, or a state Government? If so, the FCA can protect and reward you for doing the right thing by reporting the fraud. If you have any questions about whether you qualify as a whistleblower, please contact an attorney at Beasley Allen for a free and confidential evaluation of your claim. There is a contact form on this website, or you may email one of the lawyers on our whistleblower litigation team: Archie Grubb, Larry Golston, Lance Gould or Andrew Brashier.