Fake Ambulance Company Used Stolen Medicare Identities in $4.7 Million Fraud Scheme
After a North Carolina ambulance transport company went bankrupt, two people formerly associated with the defunct company created a fake ambulance company with the intention of billing Medicare for ambulance services that never occurred. According to the federal indictment, the two men stole Medicare identity information previously used to provide wheelchair and ambulance transports for a Humana Medicare program to make their false billings for reimbursement from Medicare appear legitimate.
Investigators report that the two billed Medicare for these bogus trips over an 18-month period. The checks the pair received were cashed at local check-cashing services and divided between them. Altogether, the scheme was used to bill Humana for $6.1 million, but the pair actually pocketed $4.7 million between January 2014 and June 2016.
The men also set up another account with the actual wheelchair transport company owned by one them. Using that account, they billed Humana for more fake ambulance rides and that fraud was included in the indictment.
Compliance Perspective
Failure by a nursing home to ensure that the companies used for providing ambulance transport services have completed a vendor contract and have had background checks to ensure that the company is legitimate, and the employees have not been excluded from Medicare or Medicaid reimbursemens, might be considered a violation of state and federal regulations prohibiting the use of vendors/employees who have committed crimes or who have been excluded by Medicare and Medicaid reimbursement programs.
Discussion Points:
- Review policies and procedures regarding vender contracts and background checks for ambulance companies used to transport residents.
- Train staff responsible for oversight regarding vendor contracts to ensure that no vendors are used without their having submitted a completed a vendor contract, and staff have conducted periodic background checks of the company and its employees for exclusion from Medicare and Medicaid.
- Periodically audit the vendors the facility uses to provide transportation to determine if staff are performing periodic Medicare and Medicaid exclusion background checks and whether there are completed vendor contracts on file.
