Texas Ambulance Owner Sent to Prison for Healthcare Fraud
A Texas man who owned an ambulance transport company is going to federal prison for 63-months after being convicted of conspiracy to commit healthcare fraud. The defendant knowingly billed Medicare and Medicaid for non-eligible transports.
Some of the fraudulent billings included claims for individual transports when multiple patients were transported in one ambulance.
Other fraudulent billings involved claims the defendant submitted for transporting Medicare patients via an ambulance to Partial Hospitalization Programs (PHPs) at various facilities—an unauthorized Medicare transport, and ambulance transportation services when there was no medical necessity for the transport.
The results of the defendant’s false billings to Medicare for ambulance transports that were not provided or not medically necessary is estimated at $2,835,930. The total Medicare funds deposited directly into the defendant’s company bank account for ambulance transports that were never provided or that were medically unnecessary were approximately $1,063,913.58.
The defendant’s 63-month prison sentence will be followed by three years of supervised release.
Compliance Perspective
Failing to ensure that an ambulance transport company being used by the facility has been checked for exclusion as a provider under the Centers for Medicare & Medicaid Services (CMS) and failing to make sure that a service provider has a valid and complete vendor contract on file may result in the facility being excluded as a Medicare/Medicare provider under state and federal regulations.
Discussion Points:
- Review policies and procedures regarding vendor contracts and background checks for exclusion from Medicare/Medicare reimbursement programs.
- Train staff about ambulance transports, including which services are authorized under CMS guidelines and which are not medically necessary.
- Periodically audit ambulance transport vendors to ensure that a validly executed vendor contract is on file and that the vendor has not been excluded by Medicare/Medicaid.
