In a recent case out of the Middle District of Tennessee, ambulance provider First Call Ambulance Service has agreed to pay $500,000 to settle several claims of Medicare and Medicaid fraud. The case was commenced by an undisclosed whistleblower who will share in up to 30 percent of the settlement amount. The settlement came about as a result of a joint investigation into the fraud by the U.S. Postal Service Office of Inspector General, Tennessee Bureau of Investigation, Tennessee Attorney General’s Office, and the U.S. Attorney’s Office for the Middle District of Tennessee.
Details of Case Against First Call Ambulance Services
The case against First Call Ambulance Services involves allegations of unlawful billing procedures in the provision of ambulance services to those receiving Medicaid under Tennessee’s TennCare program. The majority of these false claims involved First Call’s administration of Advanced Life Support (ALS) on patients who were not in need of such extensive resuscitation efforts. In addition, investigations revealed that First Call bills for ALS services when ALS was not even administered and the patient received basic life support (BLS), or when the patient was not in need of life support at all.
Expectedly, ALS services are more extensive – and therefore more costly – than BLS. According to the unsealed complaint, several employees of First Call became weary of the administration of ALS when seemingly unnecessary. According to one employee, he was often “confronted with a patient who plainly did not need to be transported by ambulance. Indeed, some patients were so ambulatory that they were able to walk to the vehicle and enter unassisted.”
Medicaid fraud is one of the top concerns facing state and federal health services agencies. Costing taxpayers billions annually, this crime is also one of the most common issues addressed by the False Claims Act, which has proven wildly successful in the battle against healthcare fraud.
According to U.S. Attorney David Rivera:
“Enforcement of the False Claims Act remains a top priority of the Department of Justice and this office… The U.S. attorney’s office, working with our law enforcement partners, will continue to devote the resources necessary to vigorously protect taxpayers’ interests and aggressively pursue fraud, waste, and abuse.”
In addition to the $500,000 settlement agreement, First Call has agreed to enter into a corporate integrity agreement. Pursuant to the agreement, First Call is required to implement compliance measures to ensure similar violations do not occur in the future. Entities who continue to engage in healthcare fraud and misconduct while under the guise of a corporate integrity agreement run the risk of losing their eligibility to receive reimbursement on behalf of Medicaid and Medicare patients.
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