Coast-to-coast settlements hone in on ambulance transport fraud

Prosecutors are targeting ambulance fraud schemes on both sides of the country, as evidenced by multi-million dollar settlements anounced in Florida and Southern California. 

Nine hospitals in Jacksonville, Florida, and one ambulance provider settled claims brought by federal prosecutors that the group of providers defrauded Medicare by submitting claims for non-emergency rides, according to the Wall Street Journal.

All ten defendants agreed to pay $7.5 million following a four-year investigation by the U.S. Attorney's Office for the Middle District of Florida that found ambulances owned by Century Ambulance Inc. were transporting patients that didn't require emergency transportation. Frequently, those patients were transported from one of the nine hospitals cited in the civil lawsuit to their home or to a nursing home. Medicare paid $250 million for nonemergency ambulance rides between July 2014 and December 2014, noted the WSJ. Previous reports estimate that ambulance services contribute to $350 million in fraud annually.

The settlement included hospitals from two large national health systems. Four of the hospitals listed in the settlement are owned by the Hospital Corporation of America (HCA), and four others are owned by Baptist Health. The ninth hospital is University of Florida Health Jacksonville.

Although hospitals aren't reimbursed by Medicare for ambulance transportation, investigators found that the hospitals listed in the suit were able to increase their "throughput" by decreasing the time it took to admit and discharge patients. An unnamed source told the WSJ that three other U.S. Attorney Offices are broadening their own ambulance investigations after hearing about the circumstances surrounding this case.

"There's no reason to believe this isn't going on elsewhere throughout the country," A. Lee Bentley III, the U.S. Attorney for the Middle District of Florida, told the newspaper.

On Monday, the U.S. Attorney's Office for the Southern District of California announced an $11.5 million settlment split between five ambulance providers in Orange County and San Diego. Prosecutors alleged that the companies were involved in a kickback scheme in which they provided "deeply discounted" rides to hospitals and skilled nursing facilities in exchange for Medicare patient referrals. These swapping arrangements are essentially subsidized by Medicare transports, according to the statement. 

Other states, such as New Jersey, Pennsylvania, and South Carolina have been previously identified as hot spots for ambulance fraud, leading the Centers for Medicare & Medicaid Services to implement preauthorization programs in order to combat overpayments. However, that program has been scrutinized in New Jersey for leaving patients without any means of transportation. The program already has forced the closure of eleven providers in the state.

The WSJ also reported that the U.S. Attorney's Office in Florida would also go after Jacksonville-based Liberty Ambulance that was part of the investigation, but wasn't included in the settlement. The president of Liberty Ambulance argued that ambulance billing rules are "convoluted" and lead to confusion, but not the intent to commit fraud.

For more:
- read the WSJ article
- here's the announcement from the U.S. Attorney's Office in Southern California

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