The DoJ has intervened in a qui tam case against Rural/Metro Ambulance, an Alabama ambulance company. The DoJ alleges the company violated the False Claims Act by submitting false claims for ambulance services that were never provided and were medically unnecessary. "Medicare’s regulations cover the reimbursement of certain ambulance services only if such services are furnished to a beneficiary whose medical condition is such that other means of transportation are not advised. This generally means that ambulance transportation is appropriate if the beneficiary is bed-confined or if the beneficiary’s medical condition, regardless of bed confinement, is such that transportation by ambulance is medically required. Each state’s Medicaid regulations contain similar provisions." The DoJ alleges that Rural/Metro created or submitted documentation that falsely represented that a patient was either bed-confined or that transportation by ambulance was otherwise medically required when that was not the case.
Ambulance fraud is a major problem, especially here in South Texas (San Antonio, Laredo, McAllen, Brownsville, Corpus Christi). Click here for a CIA arising out of San Antonio.