Government Joins Ambulance Fraud Whistleblower Suit

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.