One ambulance company and four hospitals in Jacksonville, Florida have opted to settle a lawsuit brought by the government in 2011 and unsealed just a few weeks ago, according to the Florida Times-Union. The settlement leaves out an additional ambulance company that now faces renewed false claims charges from the feds.
Four years ago, the feds sued two ambulance providers, Century Ambulance and Liberty Ambulance, along with four hospitals--University of Florida Health Jacksonville, Memorial Hospital, Orange Park Medical Center and Baptist Medical Center Jacksonville--according to the Times-Union. Whistleblower Shawn Pelletier, who worked as an EMT for Century Ambulance from 2004 to 2006 and with Liberty Ambulance from 2007 to 2009, said the companies falsified documents and billed for unnecessary trips. The lawsuit claims Century Ambulance billed Medicare more than $5 million, while Liberty Ambulance submitted claims totaling more than $10 million.
According to Law 360, the lawsuit alleged that companies falsified information such as heart rate and blood oxygen readings. Patients were often transported by gurney rather than a wheelchair to make it appear they had more complicated medical issues. Although the settlement has not been finalized, the Times-Union reported that it will include Century Ambulance and all four hospitals, and that the government will file a new false claims lawsuit against Liberty Ambulance in the coming months.
Century Ambulance denies any wrongdoing and says that it has appointed a compliance officer to review billing procedures. The hospitals named in the lawsuit have also denied receiving payments, but some have highlighted the complicated Medicare rules related to ambulance services, and have arranged to provide employees with additional education regarding when an ambulance in necessary.
A report in January indicated that ambulance services contribute as much as $350 million in fraudulent Medicare billing each year, often billing Medicare at elevated rates for transporting otherwise healthy dialysis patients. In December, CMS imposed preauthorization requirements in South Carolina, New Jersey, and Pennsylvania to curb overpayments, FierceHealthPayer: AntiFraud previously reported. This approach has been met with mixed reactions, as some patients have been left with no transportation options, even if physician documentation supports non-emergency transportation.