False Claims for Transporting Dialysis Patients in Ambulances Results in 9-Year Prison Sentence for Ambulance Company Owner
The owners of Alpha Ambulance Inc. are going to prison for Medicare fraud. One of the owners was sentenced to 108 months (9 years) in prison, while the other received 75 months (more than 6 years) after both pleaded guilty to a conspiracy to commit healthcare fraud.
Their company focused on non-emergency ambulance transports. Most of their patients were transported to and from dialysis treatments on a regular basis.
The government accused the company and its owners of billing Medicare for ambulance transports that were not medically necessary.
Under the Medicare rules, a dialysis patient should not be transported in an ambulance if they can be transported in a less expensive form of transportation such as a wheelchair van. An ambulance is usually not considered medically necessary unless the patient is confined to a bed or has a medical condition that requires transportation by ambulance. Most patients who can sit in a wheelchair or walk with a walker do not qualify for ambulance transports under the Medicare rules.
In this case, the defendants were accused of instructing their employees to conceal the Medicare beneficiaries’ true medical conditions and to create false justifications for the transportation.
Ambulance fraud is widespread because it all seems so easy and innocent. An EMT is instructed to check a box on a trip report or make a note that the patient is bed-confined. A doctor is asked to sign a Physician Certification Statement (PCS) stating that the patient requires an ambulance, even though the patient can walk, but he goes along with it because it will make the patient more comfortable.
These little lies add up. In this case alone, the defendants were accused of submitting more than $49 million in claims for ambulance transports.
If you have evidence that an ambulance company is submitting false claims to Medicare, or if you have been asked to provide false information on trip reports or other documents, then you should consult with an experienced Medicare fraud attorney immediately to protect yourself.
Going along with an employer who is submitting false claims to Medicare could make you, personally, a target of a criminal investigation. On the other hand, you may be entitled to a very substantial whistleblower reward if you help the government stop the fraud and recover overpayments.
To arrange and free and confidential consultation with an experienced Medicare fraud lawyer, call John Howley, Esq. at (212) 601-2728 or click here to reach our law offices via email.
John Howley, Esq.
350 Fifth Avenue, 59th Floor
New York, New York 10118