According to a recent statement from the Department of Justice, a South Carolina rescue squad has agreed to settle a qui tam lawsuit for $800,000. Williston Rescue Squad, Inc. is based in Williston, SC and provides emergency ambulance services for citizens living in the southwestern portion of the state.
According to official documents, the Williston Rescue Squad recently settled the allegations of a False Claims Act lawsuit charging the company with submitting fraudulent claims in order to receive Medicare reimbursement. In addition, Williston created false documents attempting to make the transports appear as if they met Medicare requirements. The ambulance company allegedly provided multiple transports for Medicare beneficiaries which were medically unnecessary and not considered to be emergencies. In particular, the ambulance company was routinely overbilling Medicare for transport of dialysis patients. This activity allegedly took place from 2008 through 2011.
Medicare has strict regulations when it comes to ambulance reimbursement payments. Under their guidelines, ambulance companies are only reimbursed by Medicare for transporting a non-emergent patient if:
- The patient is bed-ridden; or
- The patient has a medical condition in which any other form of transportation, such as a car, would endanger their health.
The Case Whistleblower
Sandra McKee filed the qui tam action under the provisions of the False Claims Act. McKee is a clinical social worker employed at a health care facility which routinely receives the patients who are transported by Williston Rescue. She came forward with first-hand knowledge of the fraudulent activity, filing suit on behalf of the United States government. For providing this vital information to the government via a False Claims Act complaint and putting an end to the Medicare overpayment scheme, McKee will receive $160,000 as her share of the government’s recovery or whistleblower reward.
Reaction to the Qui Tam Case
The ambulance company denied any wrongdoing and, since agreeing to the settlement, was not forced to admit any fault in the Medicare qui tam action. The Williston Rescue Squad has a $1 million contract with Barnwell County, providing emergency medical services to the area. The contract is up for renewal in June. It is not yet clear if the Medicare fraud qui tam case will have a negative effect on the contract’s renewal.
“Back in 2011, the government identified various billing concerns at the Williston Rescue Squad, which arose from claims submitted from the WRS Transport division from 2008 to 2011. These claims related primarily to the transport of dialysis patients,” said rescue squad director Phil Clarke in an e-mailed statement.
“Williston fully cooperated with the government, which resulted in a settlement agreement in which there was no admission of liability by Williston,” Clarke said. “However, to resolve the government’s concerns and to bring closure to the process, Williston agreed to make certain payments to the government.”
According to a Williston Rescue Squad spokesperson, upper-level management was replaced since the Medicare overbilling for non-reimbursable ambulance transport services occurred. The ambulance company’s “top three” managers were replaced after 2011.
“Medicare fraud is stealing, and it is crippling America’s health care system. We have doubled the number of attorneys working these cases in South Carolina. Take notice, if you are bilking the Medicare system designed to support our elders, we are working to find you. For the honest service providers, which is a greater majority of the community, you can report fraud at 1-800-MEDICARE,” said William N. Nettles, U.S. Attorney for the District of South Carolina.