John M. Almon Faces Federal Charges of Health Care Fraud, Obstructing Federal Agents

Source- http://www.justice.gov/opa/pr/2011/May/11-crm-617.html

PROVIDENCE, R.I. – The United States Attorney’s Office in Rhode Island today announced the filing of an Information in U.S. District Court in Providence charging John M. Almon, 55, of Cranston, R.I., owner and president of Med Care Ambulance LLC, of Warwick, R.I., with two counts of health care fraud, and one count each of obstructing a federal audit and making false statements. It is alleged that Almon defrauded health care programs administered by Medicare and Blue Cross Blue Shield of more than $700,000.

A not guilty plea was entered on behalf of the defendant at his arraignment in U.S. District Court in Providence on Thursday before U.S. District Court Magistrate Judge Lincoln D. Almond. Almon was released on personal recognizance. The Information alleges that John Almon defrauded Medicare of $625,825.31, and defrauded Blue Cross Blue Shield of $78,292.25.

According to the Information, beginning in March 2008 and continuing until December 2010, John Almon obtained payments in excess of $700,000 from Medicare and Blue Cross Blue Shield, by improperly submitting claims for reimbursement to health care benefit programs that falsely and fraudulently represented that Med Care had provided medically necessary Specialty Care ambulance transportation.

Court documents allege that the defendant actively solicited beneficiaries to be transported on a routine basis from their residences, either at home or a nursing facility, to renal care facilities for dialysis treatments. The majority of the transportation was routine in nature and did not require advanced or specialty care.

In addition, Almon actively solicited beneficiaries to agree to be transported for dialysis treatments by waiving the co-payment that the beneficiary would be liable for once Medicare or Blue Cross determined the amount that they would pay for services. By waiving co-payments, Med Care removed the monetary obstacle a patient might have had, and thus would agree to be transported by Med Care. Such transportation can be extremely lucrative because patients are transported two to three times a week on a round trip basis and provide a steady cash stream for an ambulance provider.

In addition to allegations of health care fraud, it is alleged in the Information that John Almon obstructed federal auditors contracted by the U.S. Department of Health and Human Services by instructing members of his executive staff to gather documents responsive to a Medicare Audit, and to “clean them up” and ensure there are no “red flags.


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