North Carolina Medical Transport Company Sentenced for Healthcare Fraud
A U.S. Attorney recently announced that a North Carolina medical transport company was sentenced, after pleading guilty in U.S. District Court in October 2018, to one count of healthcare fraud. The company was ordered to pay a $100 fine and a $400 special assessment. The company is also required to make restitution in the amount of $5,245,640.02 to the North Carolina Fund for Medical Assistance.
The transport company was originally enrolled with the North Carolina Medicaid Program in April 2008 as an ambulance provider. It provided convalescent ambulance services for non-emergency medical transportation to stretcher-bound patients. However, from November 2010 to February 2015, the company stopped operating convalescent ambulances and started providing non-emergency transport to ambulatory and wheelchair-bound clientsāthe majority of which were Medicaid recipients.
Since Medicaid did not directly reimburse companies for providing van transportation, the company could have received approval to provide non-emergency medical van transportation to ambulatory and wheelchair-bound clients by applying to the county Division of Social Services. It chose not to do so because of lower reimbursement codes for that type of non-emergency transportation. Instead, the company submitted claims to Medicaid using ambulance codes which were reimbursed at a high rate. The company was deliberately ignorant to false claims aspects because it wanted to continue receiving the higher reimbursement rates. Consequently, the false claims submitted by the transport company defrauded the Medicaid program of more than $5 million.
During the investigation, law enforcement seized and forfeited more than $5 million in cash and property representing proceeds of the scheme. Federal authorities will request authorization to apply the forfeited funds toward restitution.
Compliance Perspective
Failing to screen to ensure that medical transportation companies with whom the facility has vendor contracts are authorized to bill Medicare and Medicaid for such services may be considered a violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding vendor contracts for companies providing medical transport of residents.
- Train staff regarding the policies and procedures covering vendor contracts for medical transportation companies.
- Periodically audit to ensure that medical transportation companies being used by the facility have completed vendor contracts on file, and that they have not been excluded from Medicare and Medicaid programs.
