You think you may be having a heart attack. Or you can’t breathe. Or a loved one becomes unconscious. What do you do? You call for an ambulance, as these are often life-threatening situations. Ambulance rides that are medically necessary are a benefit on many health insurance plans, including Medicare.
In 2012, the total that Medicare paid to ambulance providers was nearly $6 billion. For perspective, that’s more money than was received by all cancer physicians during the same time period. It seems only logical that so much money would bring the fraudsters out of the woodwork. As it turns out, Medicare does have an ambulance fraud problem.
One in Five is Fraud
During 2012’s first half, roughly one in five ambulance providers nationwide (18 percent) billed for trips that were questionable, but only four geographic locations—Houston, Los Angeles, New York City, and Philadelphia—were responsible for more than half (52 percent) of those potentially fraudulent billings.
Because of these facts, the Centers for Medicare & Medicaid Services (CMS) refused to add new ambulance providers to their rolls in two of the fraud-prone locations during 2013 and 2014.
In September, 2015, a government investigation disclosed that over $50 million in possibly-fraudulent billings was paid by Medicare to ambulance companies. Perhaps the most shocking thing of all: during one six-month stretch, for $30 million worth of those rides, no evidence exists at all that patients received any care once they reached their destination.
Need some concrete examples? How about these:
- A $1.5 million scheme by an ambulance company in Philadelphia to defraud Medicare. In one case, a patient was driven four blocks to his dialysis treatment while he smoked cigarettes in the ambulance’s passenger seat. Medicare was billed $1,000 for this ride. The case went to court in 2014.
- In the Cincinnati area, an ambulance service owner admitted to submitting over $1.4 million to Medicare and Medicaid in deceitful billings over the course of seven years. He pled guilty in January, 2016, and faced up to ten years in prison for each charge of money laundering and health care fraud.
- In August, 2015, a Los Angeles federal jury convicted the former owner, operator, and managers at an ambulance company of Medicare fraud that added up to over $2.4 million.
Whistleblowers Are Coming Forward
The bright spot at the end of this tunnel of fraud is that whistleblowers are coming forward. Cases are being won against those who would commit Medicare fraud:
- One ambulance company was alleged to have committed fraud twice, in 2002 and in 2006. In the 2006 case, $9 million in penalties were paid, with $1.6 million received by the whistleblowers. In the 2002 case, penalties of $20 million were levied, with $3.8 million awarded to the whistleblower.
- One settlement for ambulance fraud by a health care company amounted to $20 million, with $2.4 million going to the whistleblowers in 2004.
- A former employee for an ambulance provider in Massachusetts brought a qui tam claim, alleging that the company’s owners repeatedly filed false claims between 2005 and 2013. The case is still open.
Under the False Claims Act, Medicare qui tam whistleblowers can be awarded between 15 and 30 percent if the suit is brought successfully. The court has discretion concerning the amount awarded.
Working with whistleblowers nationally to shed light on fraudulent practices.
If you think you have the facts needed to bring a whistleblower case, the experienced whistleblower attorneys at the Louthian Law Firm can review your case and help you file the appropriate disclosure statement. Under some circumstances, the government will intervene, or join in your lawsuit.
Your chances of succeeding are greater if your whistleblower claim is substantive, clear, and to the point.
Because of this, meeting with a qualified whistleblower attorney can increase your chances of winning. The Louthian Law Firm can help you form your claim so that the government will be more inclined to intervene in your case; government intervention can sometimes increase the chances of recovering reward money. Even if the government decides not to intervene, it could still be a good idea to pursue your case without government involvement. Our strong support system can assist you through every step of the process.