The former billing manager for MedStar Ambulance, Inc. will receive a $3.5 million whistleblower reward for reporting overbilling at the ambulance company. MedStar has agreed to pay $12.7 million to settle the whistleblower’s claims that it billed Medicare for unnecessary ambulance services. The whistleblower’s complaint alleged that the company billed Medicare for ambulance services that were not medically necessary, that were billed at higher levels of services than patients’ conditions required, and that were billed at higher levels of services than were actually provided. One of the schemes involved billing Medicare for routine trips to a doctor’s appointment or nursing home as if they were emergency runs in order to receive higher Medicare reimbursements. The whistleblower also reported that the company double-billed patients and Medicare, and that it billed Medicare when it should have billed hospitals or municipalities. The whistleblower brought his claims under the qui tam provisions of the False Claims Act. He filed a complaint “under seal” (i.e., in secret) in federal court and handed over all of his evidence to the U.S. Attorney. The government then used his evidence to conduct an investigation and pursue claims against the company. The False Claims Act provides that a whistleblower is entitled to a reward of between 15% and 30% of the amount the government actually recovers. In this case, the whistleblower will receive $3.5 million, or approximately 28% of the government’s recovery. If you have evidence of overbilling or false claims submitted to Medicare or Medicaid, then you should consult with an experienced whistleblower lawyer immediately to protect your rights. There are strict time limits and procedural requirements to preserve your claim. Call John Howley, Esq. at (212) 601-2728 to schedule a free and confidential consultation.
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Regent Management Services will pay $3.2 million to settle allegations that it received kickbacks from ambulance companies in the form of low-cost ambulance transports in exchange for referrals of Regent’s Medicare and Medicaid patients to the ambulance companies.
This is believed to be the first time a nursing home operator, as opposed to an ambulance company, has been held accountable for a “swapping” arrangement. Under such an arrangement, the ambulance company agrees to provide a nursing home or hospital with low-cost ambulance transports when the nursing home or hospital is required to pay for the transports. In return, the nursing home or hospital agrees to refer other patients to the ambulance company when Medicare or Medicaid will pay for the transports. Such “swapping” agreements violate the Anti-Kickback Statute. That law prohibits offering, paying, soliciting, or receiving anything of value in exchange for referrals of items or services covered by Medicare or Medicaid. The federal government has made clear that swapping arrangements are an area of concern throughout the ambulance industry, and that it intends to investigate and prosecute these cases aggressively. If you have evidence that an ambulance company is providing low-cost services to a hospital or nursing home in exchange for referrals of Medicare or Medicaid patients back to the ambulance company, then you should consult with an experienced whistleblower lawyer immediately. You may be eligible for a substantial financial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. If your employer is submitting false claims to Medicare or Medicaid, you have a stark choice. You can become a whistleblower and earn a substantial reward by helping the government stop the fraud, or you can go along with your employer and face serious prison time when your employer finally gets caught.
An EMT and ambulance driver in Philadelphia learned this the hard way when they were convicted on charges of conspiracy to commit health care fraud and making false statements to the government. They now face up to 15 years in prison and a $500,000 fine each when they are sentenced. According to the government, Brotherly Love Ambulance, Inc. submitted false claims to Medicare and Medicaid for ambulance transports that were not medically necessary and were not provided in ambulances with the required lifesaving equipment. In addition to prosecuting the owner of the ambulance company, the government also prosecuted the Emergency Medical Technician (EMT) and ambulance driver who prepared the “run sheets” for the ambulance transports. EMT Fritzroy Brown and ambulance driver Thael Kuran were convicted of signing false run sheets or trip reports that the ambulance company used to support its claims to Medicare and Medicaid. According to the government, the run sheets misstated the patients’ medical conditions by failing to disclose that the patients were able to walk. Under Medicare and Medicaid regulations, patients who are not bed confined and are able to walk are not eligible for ambulance transport reimbursement. They must be transported in less expensive medical vans. The run sheets also indicated that the patients were always transported in ambulances when, in fact, they were sometimes transported in vans that lacked the lifesaving equipment required for ambulance transports. The ambulance company used these false run reports to bill Medicare and Medicaid for more expensive ambulance transports. The EMT and ambulance driver in this case could have made a much better choice. If they had consulted with a whistleblower lawyer, they could have earned a large financial reward and most likely avoided any criminal charges. Under the False Claims Act, an individual with evidence of false claims to Medicare or Medicaid can file a lawsuit “under seal” (that is, in secret) and present their evidence to the government. If the government recovers money as a result of the lawsuit, the whistleblower is entitled to a reward of between 15% and 30% of the amount recovered. If you have evidence that your employer is submitting false claims to Medicare or Medicaid, do not go to prison for them. Contact an experienced whistleblower lawyer and find out if you are eligible for a substantial financial reward and legal protections as a whistleblower. To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728. Employees Face Prison Because They Went Along with Employer’s Medicare Fraud
The former billing manager and EMT supervisor of an ambulance company in Los Angeles have been found guilty of health care fraud. The defendants were charged with helping the owners of the ambulance company bill Medicare to transport dialysis patients in ambulances, when the patients could have been transported by less expensive means. This case is a warning for any employee who knows that their employer is engaged in Medicare fraud. When the government finds evidence of fraud, it prosecutes everyone who was involved, not just the owners of the company who benefitted from the scheme. You could go to prison for going along with your employer’s fraud. In the recent ambulance fraud case, the government charged two employees – the billing manager and EMT supervisor – with helping the owners bill Medicare for ambulance transportation services for individuals who did not need such services. Their “guilty conduct” included transmitting the owners’ instructions to the EMTs who created trip reports or run sheets. For example, the government introduced evidence that EMTs were instructed to conceal the true medical conditions of patients they were transporting by creating false trip reports to justify the transportation services. By transmitting these instructions from the owners of the ambulance company to the EMTs, the billing manager and the EMT supervisor became part of the conspiracy to defraud Medicare. Now they are facing lengthy prison sentences because they went along with their employer’s fraud. Do not go to prison for your employer’s Medicare fraud. If you know that your employer is submitting false claims to Medicare, then you should consult with an experienced whistleblower lawyer immediately to protect yourself. You may be entitled to a substantial reward and legal protections as a whistleblower. You may also be able to avoid criminal prosecution, even if you had some involvement in the fraud. Do not wait until the FBI comes knocking at your door. Call John Howley, Esq. at (212) 601-2728 to schedule a free and confidential consultation with an experienced whistleblower lawyer. Ambulance Company Accused of Improperly Receiving $28 Million from Medicare and Medicaid by Offering Discounts in Return for Patient Referrals and by Submitting False Claims for Medically Unnecessary Ambulance Transports
The U.S. government has agreed to join a lawsuit that was started by a whistleblower against an ambulance company under the False Claims Act and the Anti-Kickback Statute. The complaint alleges that the ambulance company improperly received $28 million in reimbursements from Medicare and Medicaid as a result of the false claims. The lawsuit was originally filed under the whistleblower or qui tam provisions of the False Claims Act by Shawn Pelletier, a former employee at Liberty Ambulance. Under the False Claims Act, he will be entitled to a whistleblower reward of between 15% and 25% of the amount the government recovers because of his lawsuit. In this case, that could mean a whistleblower reward of as much as $4.2 million to $7 million. The complaint alleges two types of false claims: one that is fairly common under the False Claims Act; and a second that explains the broad reach of the Anti-Kickback Statute. The first set of claims allege that Liberty Ambulance submitted false claims for ambulance transports that were medically unnecessary, predicated on false statements, and should not have been reimbursable. The complaint alleges that the ambulance company trained its employees to falsify records and to make false statements to support claims for medically unnecessary ambulance transports. The second set of claims allege that the ambulance company violated the Anti-Kickback Statute by offering discounts to private healthcare providers – such as hospitals and skilled nursing facilities – in return for referrals of patients who were covered by Medicare and Medicaid. The complaint alleges that the ambulance company failed to offer these same discounts to the government. Under the Anti-Kickback Statute, it is illegal to offer or accept anything of value in return for referrals of patients covered by Medicare or Medicaid. Kickbacks obviously include cash payments, but they may also include non-cash benefits such as discounted rates on services for hospitals and nursing homes, free medical supplies or gift cards for patients, free office space or subsidized office staff for doctors, excessive compensation for medical directorships, or anything else of value. Once a kickback has been paid, any claims submitted to Medicare or Medicaid are considered “false claims,” even if the services were medically necessary and actually provided to the patient. If you have evidence that a healthcare provider is submitting false claims to Medicare or Medicaid – or that a healthcare provider is offering anything of value in return for patient referrals – then you should consult with an experienced whistleblower lawyer immediately. You may be entitled to a substantial reward and protections as a whistleblower. To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. |