Maine Ambulance Company Settles False Claims Act Allegations
A U.S. Attorney recently announced that a Maine ambulance company has agreed to settle allegations that it violated the False Claims Act by billing and receiving payment from Medicare for nonemergency ambulance transports originating from a Maine medical center. The company will pay $138,285.30 to the government.
During a period from October 2016 through February 2018, the government contended that the patients involved in the ambulance transports were not “bed-confined,” and did not have other medical needs for being transported by ambulance. The government also asserted that personnel from the medical center provided the ambulance company with certification statements containing incomplete or incorrect information about the medical necessity of transporting the patients via ambulance. That information was then used by the ambulance company to bill Medicare.
Prior to the government’s lawsuit, the company voluntarily disclosed and identified instances where it had billed and received payment from Medicare for nonemergency ambulance transports from the medical center that were unnecessary.
The company also cooperated throughout the investigation and has implemented enhanced internal compliance and remedial measures.
Compliance Perspective
Providing incomplete or incorrect certifications to an ambulance company about patients’ medical necessity for transport via ambulance which are then used by the ambulance company to file false claims to Medicare, may result in a facility being excluded from participating in Medicare reimbursement programs.
Discussion Points:
- Review policies and procedures regarding the protocols for issuing certification statements and ensuring that only complete and correct information is provided to vendors.
- Train staff regarding the importance of following the policies and procedures intended to prevent submission of false claims to Medicare to avoid jeopardizing the facility’s inclusion status as a Medicare provider.
- Periodically audit the certification statements provided to ambulance providers and other vendors to determine if they contain incomplete or incorrect information that could result in filing of false claims to Medicare.
