United States Attorney Maria Chapa Lopez announced yesterday that AmeriCare Ambulance Service, Inc. and its sister company, AmeriCare ALS, Inc. (collectively, AmeriCare), have agreed to pay approximately $5.5 million to resolve allegations that they defrauded Medicare by billing for medically unnecessary ambulance transportation services.
“Fraudulently billing the government for medically unnecessary ambulance transports poses a heavy drain on the Treasury, deprives federal health care programs of valuable resources, and will not be tolerated,” said U.S. Attorney Chapa Lopez. “This lawsuit and today’s settlement evidence our office’s ongoing efforts to safeguard federal health care program beneficiaries from the effects of this type of unlawful conduct.”
According to a complaint filed by the government last year, from January 2008 through December 2016, AmeriCare submitted fraudulent claims to Medicare and TRICARE for Basic Life Support (BLS), non-emergency ambulance transports that were not medically justified. In support of these allegations, the government cited information regarding unwarranted ambulance transports it had received from numerous AmeriCare employees, as well as audits conducted by the agencies that administer Medicare and TRICARE. The government also cited damaging testimony it had elicited under oath from members of AmeriCare’s management team during the course of the investigation. This testimony, along with the other evidence obtained by the government, revealed that AmeriCare had engaged in a systemic practice – over many years – of submitting fraudulent claims to the government falsely attesting to the medical necessity of its non-emergent, BLS ambulance transports. That proof also revealed that AmeriCare had created thousands of false reports and other documentation during this time period, in a failed effort to support this illicit practice.
In addition to paying approximately $5.5 million, AmeriCare has also agreed to enter into an integrity agreement with the Inspector General of the U.S. Department of Health and Human Services.
“Medical service providers who engage in systemic fraud at the core of their business levy an assault on federal health care programs and the American taxpayer,” said Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services, Office of Inspector General. “In spite of often false medical documents, the OIG and our partners will not be deterred in our efforts to root out this type of fraud and protect the American public.”
“This settlement demonstrates the effectiveness of investigations by the Defense Criminal Investigative Service and our law enforcement partners to ensure that medical service providers do not bill for unnecessary services that divert and waste precious taxpayer dollars,” said Special Agent in Charge John F. Khin, Southeast Field Office. “DCIS protects the integrity of DoD programs by rooting out fraud, waste, and abuse that negatively impacts critical programs such as TRICARE.”
This settlement concludes a lawsuit originally filed by a former AmeriCare employee, Ernest Sharp. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act that permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action, as it did here. Mr. Sharp will receive roughly $1.15 million of the proceeds of the settlement with AmeriCare.
The case is captioned United States, et al. ex rel. Sharp v. AmeriCare Ambulance, Case No. 8:13-cv-1171-T-33AEP. The settlement resolves the United States’ claims in that case. The claims resolved by the settlement are allegations only and there has been no determination of liability.
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