Ambulance fraud is on the rise in Florida, and taxpayers are paying the bill. In September 2015, the Department of Health and Human Services, Office of Inspector General (“OIG”) issued a report titled Inappropriate Payments and Questionable Billing for Medicare Part B Ambulance Transports. In May 2015, the United States Attorney for the Middle District of Florida also reached a $7.5 million settlement with several Jacksonville-area health facilities and an ambulance provider for various ambulance fraud schemes.
Here’s the issue. Medicare pays for non-emergency ambulance transportation for Medicare beneficiaries when other means of transportation would endanger the person’s health. The transportation must be for medical purposes, like attending a doctor’s appointment, not for grocery shopping. As an example, an elderly Medicare beneficiary may need non-emergency ambulance transportation to receive kidney dialysis treatment. To justify the transportation, however, the ambulance ride must be “medically necessary.” The person must not be able to drive himself or herself, take a bus, or arrange other transportation, without endangering his or her health.
Unfortunately, dishonest ambulance companies and healthcare providers often bilk taxpayers for bogus ambulance services. Sometimes, Medicare beneficiaries themselves are complicit with the fraud, treating the ambulance ride as a free taxi service (at the taxpayers’ expense).
Here are some common fraud schemes involving ambulance transportation:
· Providing ambulance transportation to Medicare beneficiaries who do not need it. In many cases, the Medicare beneficiaries are perfectly capable of driving themselves. In extreme cases, the beneficiary even rides in the passenger seat of the ambulance!
· Providing ambulance transportation without adequate personnel. To bill Medicare for an ambulance ride, the company must have properly trained people on board. Often, this is not the case.
· Up-coding ambulance transportation from “basic life support” to “advanced life support,” which is more expensive.
· Providing service without an ambulance. Because many of these bogus rides are nothing more than an expensive taxi, some ambulance companies don’t even bother to use a real ambulance and instead substitute cargo vans. This is an extreme example of fraud – billing for an ambulance without a real ambulance.
· Paying kickbacks in exchange for ambulance referrals. Many times, hospitals, nursing homes, and skilled nursing facilities arrange for ambulance transportation for Medicare beneficiaries. Generally, these facilities must issue a Certificate of Medical Necessity to attest that the ambulance transports are really necessary. Dishonest ambulance companies will pay kickbacks to these facilities in exchange for bogus certificates, which open the way for fraudulent billing.
With its large elderly population, Florida is vulnerable to this type of fraud against the taxpayers. Large metropolitan areas like Orlando, Tampa, Miami, and Fort Lauderdale are especially vulnerable. If you know about a healthcare provider that engages in this type of deceptive practice, you may be able to bring a qui tam whistleblower case. Contact our attorneys for a free consultation.