Who knew that ambulance misuse was such a big driver of health care fraud? Apparently, the federal government did. A report by the Philadelphia Business Journal points to ten Philadelphia-area ambulance companies that were recently indicted for filing fraudulent Medicare claims to the tune of $20 million, over the past five years. (That’s a reason to sound the sirens!)’
Keep in mind that Medicare (along with probably every private provider in existence) does not cover ambulance transportation costs unless other transportation could endanger a patient’s health. The Journal report centers on one particular ambulance company, whose owner, employees and even patients collaborated on a scheme that defrauded Medicare using a number of different deceptions. (No points for creativity in cheating.)
The company submitted to Medicare reports that falsified some patients’ need to be transported by ambulance. The scam also involved offering patients incentives to develop ailments that “required” ambulance rides. (How did that work—here’s twenty bucks to pretend you’re unconscious?) Additionally, the company submitted claims for ambulance rides, when, actually, the patients had been driven in personal vehicles.
But remember: this company was only one of many conducting similar schemes (sigh), so it was only a matter of time before the federal government took notice. And, boy, did they. A joint investigation by the Department of Health and Human Services, the Federal Bureau of Investigation and the Department of Labor ended with an array of indictments, prison sentences and orders for restitution. Ultimately, the owner of the company detailed above pleaded guilty to health care fraud and violating the Anti-Kickback Act, for which she was sentenced to 64 months in prison and ordered to pay back $2 million to Medicare. Similarly, a medical technician she employed received a 37-month prison sentence, was ordered to pay $2 million in restitution to Medicare, another $14,150 to Pennsylvania and a $300 special assessment. There was no ‘brotherly love’ to be found in this story.
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