Thursday, September 1, 2011

Government Recovers More Than $1.6 Million from 11 Cities to Resolve Allegations They Caused Improper Medicare and Medicaid Ambulance Claims


DALLAS—The Texas cities of Plano, Frisco, Richardson, Mesquite, Celina, DeSoto, Corpus Christi, Cedar Hill, Rowlett, North Richland Hills, and University Park (collectively “Cities”) have agreed to pay the U.S. and Texas the collective amount of $1.69 million to resolve allegations they violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney James T. Jacks of the Northern District of Texas. The U.S. and Texas contend all the Cities caused “upcoded” claims to be submitted to Medicare and Medicaid for city-dispatched 911 ambulance transports between 2006 and 2010. All the Cities fully cooperated with the investigation, and by settling, did not admit any wrongdoing or liability.

Ambulance services generally are coded either as basic life support level or advanced life support (ALS). ALS transports are reimbursed at a higher rate by both Medicare and Medicaid. The U.S. and Texas contend the Cities’ billing contractor coded 911-dispatched transports at the ALS level, which indicates an ALS service was furnished and/or the patient’s condition necessitated an ALS intervention. The U.S. and Texas allege the Cities caused to be submitted for payment claims falsely representing to Medicare and Medicaid that such ALS services were appropriate and furnished by their personnel when in fact no ALS service was rendered and/or the patient did not require an ALS transport.

The U.S. and Texas initiated the investigation in response to a February 2010 whistleblower suit brought by Douglas Moore. Under the False Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may bring actions alleging fraud on behalf of the government and collect a share of any proceeds recovered by the suit. Mr. Moore can receive up to 30 percentof the recovery under the settlement.

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