Ambulance Billing Fraud Attorneys
Our Health Law Group assists health care providers, insurance companies, clearinghouses, supply companies, and all related business associates defend against charges and allegations of health care fraud.
Charges of ambulance billing fraud can affect all kinds of Emergency Medical Services (“EMS”) professionals including owners and operators of ambulance companies and employees. We help our clients deal with government investigations and advise them on how to meet their compliance goals.
Call 844-239-1234 for a
Free Confidential Case ReviewAmbulance Billing Generally
“Ambulance billing fraud” involves submitting false claims for ambulance transport services. Allegations of “ambulance billing fraud” usually stem from billing Medicare or Medicaid programs for medically unnecessary transport services. They also stem from submitting false or inflated claims for ambulance transports.
There are around 10,000 ambulance companies in the United States and hundreds of thousands of credentialed EMS professionals.
These companies provide out of hospital care for people with illnesses and injuries and operate in conjunction with many different types of healthcare providers including, emergency medical technicians, paramedics, nurses, and physicians.
Many of these companies are small operations, consisting of volunteers and around one or two transport vehicles. Other ambulance companies are large and privately owned and consist of thousands of employees.
No matter what the size of your company, submitting false claims for transportation services is a serious offense and could lead to fines, imprisonment, and the revocation of your professional licenses.
What is “Ambulance Billing Fraud?”
“Ambulance billing fraud” involves submitting false claims for ambulance transport services. Allegations of “ambulance billing fraud” usually stem from billing Medicare or Medicaid programs for medically unnecessary transport services. They also stem from submitting false or inflated claims for ambulance transports.
What Makes Some Ambulance Transports Illegal?
Generally, claims for ambulance transports are improper and illegal if they are:
- Not medically reasonable or necessary;
- Do not qualify as “Special Care Transports”;
- Were billed for higher levels of services than were actually provided;
- Were billed for higher levels of services than were required by patients’ conditions; or
- Were billed to federal health care programs when they should have been billed to someone else.
Example
In 2018, Hart to Heart Transportation Services was put under investigation for allegedly falsifying Medicare claims by stating that newly-discharged hospital patients who could not walk out of the hospital on their own two feet needed ambulances because they could not stand without “maximum assistance.”
Even if the patient could leave in a wheelchair or with some other form of support, employees of the company claim that they were forced to file for an ambulance transportation claim and if they refused to make the report, they would face suspension or be fired.
Companies have also been accused of altering their patient’s paperwork in order to create fraudulent reasons to justify the ambulance services.
You may discover more examples of cases like this in our “Press Release” section below.
Who Can Be Found Liable for Ambulance Billing Fraud?
All ambulance companies that provide community-based medical transportation services can be found liable for health care fraud, conspiracy to commit health care fraud, or for violating the False Claims Act.
What is the False Claims Act?
The False Claims Act (“FCA”) is a federal law that says it is unlawful to knowingly makes a false claim or a false statement in order to improperly obtain an insurance payment.
“Knowledge” of the false statement means you:
- Had actual knowledge that the claim was false;
- Deliberately ignored the truth; or
- Recklessly disregarded the truth.
Basically, receiving money from a government program (like Medicare or Medicaid) under false pretenses is illegal.
Ambulance companies that knowingly submit claims false claims to receive money from the government or avoid paying money to the government will be liable for violating the False Claims Act.
Penalties for Violating the False Claims Act
Ambulance companies that violate the False Claims Act may face fines of up to $250,000, five years imprisonment, or both, for each false claim made.
What About Health Care Fraud Generally?
The Federal Healthcare Fraud Statute makes it a felony to defraud a health care benefit program or obtain money from a health care benefit program under fraudulent pretenses.
For ambulance companies, violation of the health care fraud statute usually includes:
- fabricating trips taken or services rendered;
- providing trips that are not reasonably necessary;
- billing multiple health care providers for services rendered;
- billing for patients that you never transported or provided services to;
- fabricating or altering patient documentation to justify transport services;
- coercing a patient into believing your services are medically necessary; or
- overstating or exaggerating a patient’s condition to encourage transport services.
Call 844-239-1234 for a
Free Confidential Case ReviewPenalties for Violating the Federal Health Care Fraud Statute
Ambulance companies and employees found guilty of violating the Federal Health Care Fraud Statute may face fines of up to $250,000, or imprisonment for up to 10 years.
Penalties are generally determined by your criminal history, how much money was obtained in the fraud, and how many times you attempted to defraud the public government program or private health care provider.
Who is in Charge of Health Care Fraud Investigations?
Illegally billing federal health care programs to increase revenue is a serious matter. The federal agencies who are in charge of dealing with charges and allegations of ambulance billing fraud take these investigations very seriously.
The federal agencies involved in investigating charges of health care fraud include:
- The Office of the Inspector General (“OIG”);
- The U.S. Department of Health and Human Services (“HHS”);
- The Department of Justice (“DOJ”) Health Care Fraud Unit;
- The Federal Bureau of Investigations (“FBI”) Health Care Fraud Unit;
- The National Insurance Crime Bureau (“NICB”);
- The Coalition Against Insurance Fraud (“CAIF”); and
- The National Association of Insurance Commissioners (“NAIC”).
Generally, the Justice Department’s Criminal Division (“DOJ”), Federal Bureau of Investigations (“FBI”), Department of Health and Human Services Office of the Inspector General (“HHS-OIG”), and local prosecutors will work together to investigate and prosecute charges of health care fraud.
Medicare Fraud Strike Force
In 2007, the U.S. Department of Health and Human Services Office of the Inspector General (“HHS-OIG”) created a Medicare Fraud Strike Force to combat health care fraud, including the unnecessary or improper billing of emergency and non-emergency transportation services.
Health Care Fraud Prevention and Enforcement Action
In 2009, the Attorney General and the Secretary of Health and Human Services also launched the Health Care Fraud Prevention and Enforcement Action (“HEAT”) initiative to combat health care fraud.
How Are Healthcare Fraud Investigations Carried Out?
Healthcare fraud investigations can involve interviewing:
- the patient who was transported;
- the individual who filed the claim;
- the doctor who made the diagnosis;
- the doctor who authorized the treatment;
- the doctor who carried out the treatment or procedure;
- the medical staff who helped a clinic perform treatments.
Additional methods used in healthcare fraud investigations include:
- auditing of medical records;
- checking your history of claims; and
- examining physical evidence like patient injuries or documents referring to them.
How Can I Defend Myself Against Charges of Submitting a False Claim?
In order to be found liable under the False Claims Act, an individual must have had “knowledge” that the claim was false. For example, submitting a false claim by accident would not trigger liability.
Prosecutors may prove your guilt by providing evidence that you knowingly presented a false claim for payment or approval. An example of this would be double billing multiple health care providers or filing a claim for services you never rendered.
Prosecutors may also prove your guilt by proving you knowingly made a material false or misleading statement in connection with a claim.
This means that even if you do not completely fabricate claims for transport services you may still be found liable for any statement made in connection with the claim if you knew that it would be likely to mislead the health care provider.
Call 844-239-1234 for a
Free Confidential Case Review“Ambulance Billing Fraud” in the News
Ambulance Company Pays $9 Million to Resolve False Claims Act Allegations.
Charge: False Claims Act Violation
Allegations: Submitting False Claims for Ambulance Transports
In 2018, an ambulance company, Medical Transport LLC, agreed to pay $9 million to resolve allegations that it violated the False Claims Act by submitting false claims for ambulance transports.
According to the DOJ press release, the company improperly submitted false or fraudulent claims to Medicare, Medicaid, and TRICARE.
These claims were improper and illegal because they were allegedly made for ambulance transports that were:
- Not medically necessary;
- Did not qualify as “Special Care Transports”; or
- Were billed to federal health care programs when they should have been billed to someone else.
As part of the settlement, Medical Transport LLC also had to agree to be monitored for five years by the Office of Inspector General and Department of Health and Human Services.
To learn more about this case, click this link, or copy the URL below:
https://www.justice.gov/opa/pr/ambulance-company-pay-9-million-settle-false-claims-act-allegations
Ambulance Company Pays Over $12.5 Million to Settle False Claims Act Allegations.
Charge: False Claims Act Violation
Allegations: Submitting False Claims for Ambulance Transports
In 2017, an ambulance company, Medstar Ambulance Inc. (“Medstar”), and four of its subsidiary companies agreed to pay almost $13 million to settle allegations that they knowingly submitted false claims to Medicare.
According to the DOJ press release, Medstar routinely billed for services that did not qualify for reimbursement because the transports were not medically reasonable and necessary, billed for higher levels of services than were required by patients’ conditions, and billed for higher levels of services than were actually provided.
The claim was filed by a former employee of Medstar’s billing department. According to the whistleblower provisions of the False Claims Act, private individuals may sue on behalf of the United States and share in the proceeds of any settlement or judgment.
The whistleblower in this case, Dale Meehan, received around $3.5 million of the $12.7 million that Medstar paid to resolve the allegations.
To learn more about this case, click this link, or copy the URL below:
Employee of Ambulance Company Sentenced to 3 Years for Billing Fraud.
Charge: Conspiracy to Commit Health Care Fraud & False Claims Act Violation
Allegations: Submitting False Claims for Ambulance Transports
In 2018, an employee of an ambulance company, Aharon Aron Krkashatyan, was sentenced to 3 years imprisonment for his role in a scheme to defraud the federal Medicare program.
According to the DOJ press release, Krkashatyan admitted that he and his company, Mauran Ambulance Inc. (“Mauran”), conspired to increase revenue by submitting fraudulent ambulance transport service claims to Medicare for individuals who did not actually need these services.
Mauran was an ambulance transportation company in Southern California that provided non-emergency services to Medicare beneficiaries. Most of Maurans’ patients were dialysis patients who needed transportation to blood transfusion centers.
To carry out the fraud, Mauran concealed patients’ true medical conditions in order to justify their transportation claims to Medicare.
Specifically, Mauran emergency medical technicians were instructed to alter paperwork and create fraudulent reasons to justify the ambulance services.
During the conspiracy, Mauran submitted over $28 million in claims to Medicare.
In total, almost $7 million of those claims were false and fraudulent claims for medically unnecessary transportation services. The federal Medicare program eventually paid about half of these false and fraudulent claims (over $3 million.)
5 individuals were charged in the conspiracy, including:
- The owner of Mauran;
- The general manager of Mauran;
- The dispatch supervisor at Mauran;
- The quality improvement coordinator of Mauran (Krkashatyan); and
- An employee of a Los Angeles dialysis treatment center.
Krkashatyan eventually plead to one count of conspiracy to commit health care fraud. All other co-conspirators have pleaded guilty and are awaiting sentencing.
To learn more about this case, click this link, or copy the URL below:
Call 844-239-1234 for a
Free Confidential Case ReviewCharges of defrauding government programs like Medicare and Medicaid can have a devastating impact on your family, your business, your future in the profession.
That is why you need an experienced health care fraud attorney.
Our attorneys understand the healthcare industry and can help you understand the charges that are being brought against you. We can accompany you to interrogations and ensure that your rights are not violated. Ultimately, our goal is to help you establish a legitimate defense.
We have the knowledge and background to successfully defend anyone prosecuted for healthcare and insurance fraud in both state criminal and civil proceedings and federal criminal and civil proceedings.
We have represented industry and corporate clients, doctors, pharmacists, administrators, clinics, hospitals, and other health care industry professionals.
If you or someone you love has been charged with health care fraud related to the improper billing of transportation services, call our attorneys for a free legal consultation.