How to Report EMS Fraud and Receive a Whistleblower Reward
Do You Have Evidence of Ambulance Medical Transport or EMS Fraud?
Ambulance billing fraud. The government estimates that the taxpayer funded Medicare program loses $250 million per year because of fraudulent billing related to EMS services and ambulance transports. It’s hard to estimate the loss to Medicaid because each state has different record keeping but the losses are also in the tens of millions of dollars each year.
When ambulance services, medical transport companies or EMS businesses cheat Medicaid and Medicare, everyone loses. Ambulance fraud schemes occur when someone submits a claim to Medicaid for ambulance or EMS transportation or medical services that are not provided, are overbilled, are medically unnecessary or violate Anti-Kickback statutes.
Tipsters who report Emergency Medical Services or Ambulance Transport Fraud can earn large cash rewards under their state False Claims Act.
Medicaid Patient Ambulance Transport or EMS Fraud Violates False Claims Acts
People with inside information or evidence about fraudulent ambulance transportation or emergency medical service billings, may be entitled to cash rewards for reporting Medicaid fraud. Typical ambulance and EMS scams that include:
Billing for medically unnecessary services: Transporting patients to treatment centers when the passenger is able to be transported via public transportation, taxi, wheelchair van or personal vehicle. Common examples include ambulance services that offer “free” rides to elderly patients needing rides to routine medical appointments. There is nothing “free” about these rides. In 2018, ambulance transports often cost more than $1000 per trip. These scams often involve patients needing dialysis services. Three dialysis sessions per week, two trips each (to and from) adds up to $156,000 per year per patient at just $500 per transport.
A variation of this scheme occurs when hospitals use ambulance services as a taxi service simply to free up bed space and get people home or back to a nursing home so they can free up a bed and admit a new patient. Hospitals will sign a medical necessity certificate even though there was no need for an ambulance.
Billing for services not provided: Billing Medicaid for transportation services, treatment procedures or life support procedures that were never provided.
Overbilling: Billing for full service ambulance transportation when transport was provided by other, lesser equipped vehicles (medical assistance van, ambulance).
Another variation is billing for advanced life support (ALS) services while only supplying basic life support (BLS) services.
Upcoding: Closely related are schemes when an ambulance will start an IV or administer oxygen simply to elevate a basic transport into an ALS run.
Anti-kickback violations: Providing discounts or gifts to medical institutions or medical providers in exchange for transportation referrals. Kickbacks need not be in cash. Some nursing homes will offer exclusive transportation arrangements – meaning more Medicare billing – in return for taking patients to or from routine visits.
Some hospitals will pay kickbacks in order to get ambulances to bring patients to their facility instead of another (and often closer) facility.
Under the federal Anti-Kickback Statute, it is illegal for anyone to pay money or give something of value in the hopes of getting healthcare business or referrals. Medical decisions should be based on the best interests of the patient and not on who pays the biggest bribes.
Real Whistleblower Story – Paramedics Plus and $4.9 Million Whistleblower Award: In August 2018, East Texas Medical Center Regional Healthcare System, Inc., East Texas Medical Center Regional Health Services, Inc. and their affiliate ambulance company, Paramedics Plus, LLC paid $21 million to settle a whistleblower claim alleging an EMS fraud involving illegal kickbacks.
Dr. Stephen Dean claimed Paramedics Plus paid bribes and kickbacks to gain lucrative EMS contracts in California, Texas, Oklahoma and Florida. According to his complaint, Paramedics Plus paid political contributions to elected officials where they had government contracts for EMS services and also disguised kickbacks through a novel arrangement called a “profit cap.”
The profit cap arrangements work by letting the ambulance company get an overpriced contract. A portion of any “excess” profits are funneled to a trust or third party. Everyone but the taxpayer wins. And if you are a patient and don’t have insurance, watch out! Your ambulance bill may be double what municipal ambulance services charge.
For his efforts in coming forward and reporting Paramedics Plus, Dr. Dean received a whistleblower award of $4.9 million.
Whistleblowers Reporting Ambulance or EMS Fraud are Eligible for Cash Rewards
Anyone with inside information about ambulance billing scams may be eligible for an award.
The federal government pays whistleblower awards for information about EMS fraud involving Medicare, Tricare and the federal match of Medicaid. 29 states have similar rewards for state funded Medicaid. [California and Illinois have private insurance whistleblower reward laws that pays for ambulance fraud information involving traditional health insurance such as Blue Cross or Humana.]
All these laws include whistleblower provisions offering cash awards of fifteen to thirty percent of monies recovered for people who were the first to report fraud with information or evidence to help the authorities build Medicaid EMS or ambulance fraud cases.
In certain instances, California can pay up to 50%.
How to Claim a Reward for Reporting Ambulance Fraud
Many people think that calling a government toll free hotline gets you an award. That doesn’t work. While there is nothing report with reporting fraud to the national 1-800 MEDICARE number, doing so doesn’t get you an award.
So how do you get an award for reporting EMS fraud? It isn’t as difficult as you might think.
Step one is hiring an attorney. (Most lawyers handle cases on a contingent fee basis, we can help!) The attorney then investigates your claim and files a sealed lawsuit in federal court. (In some Medicaid cases, state court.)
Worried about retaliation? Whistleblowers are protected from losing their job under both state and federal law. It is illegal to fire, demote or harass employees who report fraud. The penalties are substantial for a company that retaliates against an employee for reporting Medicaid or Medicare fraud.