Ambulance fraud masterminds brought to justice

Ambulance fraud contributes to as much as $350 million in fraudulent payments each year. This week, some of those fraudulent schemes were exposed--and the perpetrators face harsh sentences.

On Monday, the general manager of a Southern California ambulance company was sentenced to nearly seven years in prison for his role in a $5.5 million fraud scheme, according to a release by the Department of Justice. In September, Wesley Harlan Kingsbury pleaded guilty to a scheme in which he conspired with a training supervisor and two other owners of Alpha Ambulance Inc. to bill Medicare for ambulance transportation services that were not required. Kingsbury also told emergency medical technicians to alter patient paperwork in order to justify the ambulance rides.

In 2012, Kingsbury admitted to Medicare auditors that he and his conspirators altered patient documentation by tracing over original documents, submitting the falsified copies to Medicare and shredding the originals. Later that year, when approached by federal law enforcement officials, he denied disclosing this information. The three others involved in the scheme were previously sentenced to 75 months, 108 months and 30 months, respectively.

Meanwhile, the owner of the ambulance company, River Valley Transport in McAllen, Texas, pleaded guilty to submitting false claims to Medicare and the state Medicaid system for ambulance transportation that were not provided, according to the U.S. Attorney's Office of the Southern District of Texas. Frank Gonzalez forged patient documents and billed federal programs for transporting dialysis patients when beneficiaries did not go to dialysis clinics. Gonzalez also used a minivan to transport patients and then billed Medicare for higher-paying ambulance transportation services.

Finally, a West Virginia man was charged with bribery and false claims that could send him to jail for up to 10 years, according to a release by the West Virginia Department of Health and Human Services. James Cecil Nance, who served as the director of operations of the American Ambulette & Ambulance Service Inc., allegedly billed Medicaid for transportation service without a license for an advanced life support (ALS) ambulance. Prosecutors allege that Nance directed employees to submit false claims for ALS services for more than a year for more than $20,000.

CMS recently extended its moratoria on ambulance services in certain parts of the country. Ambulance transportation services are a prominent risk linked to fraudulent billing, FierceHealthPayer: AntiFraud previously reported.

For more:
- read the DOJ release
- here's the Texas U.S. Attorney's release
- read the West Virginia HHS release
- read the CMS moratoria (.pdf)