Department of Justice is Getting Aggressive in Health Care Fraud Cases

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On March 4, 2016, the U.S. Department of Justice (DOJ) announced that it had entered into a settlement agreement with a Grand Forks, North Dakota provider of ambulance services, in which the provider agreed to pay more than $300,000 to resolve allegations that it had fraudulently billed Medicare. Earlier this year, the DOJ reached settlements of smaller amounts with ambulance service companies in a number of other states, including settlements of:

  • $100,000 with a Connecticut firm
  • $77,000 with an Illinois firm
  • $113,000 with a Michigan firm
  • $74,000 with a Massachusetts firm

In each of the cases, the DOJ contended, among other things, that the firms submitted claims for emergency ambulance transportation to destinations, such as skilled nursing facilities and patient residences, that should have been billed at lower non-emergency rates.

Prison Terms, in Addition to Orders of Restitution

Last December, in yet another case, the DOJ announced prison sentences for various officials of a California ambulance company that had conspired to bill Medicare for unnecessary transportation. The prison sentences ranged from 24 months up to 108 months. The convicted billing manager and supervisor were also ordered to pay more than $800,000 in restitution.

$3.1 Million Settlement Involving Ambulances Services in Texas

These settlements come on the heels of a much larger settlement last year involving a Galveston, Texas firm that operates 12 skilled nursing facilities (11 in Texas, one in Nevada) and several Texas ambulance services firms. In that settlement, the nursing home firm agreed to pay more than $3.1 million in connection with allegations that it received kickbacks from various ambulance companies, in exchange for rights to the firm’s more lucrative Medicare and Medicaid transport referrals.

Both Sides of Swapping Arrangement Can Be Held Liable

The Galveston settlement was believed to be the first in which the medical institution, rather than the ambulance companies, was held responsible for this kind of ambulance “swapping” arrangements. The federal Office of the Inspector General stressed that both sides of a swapping arrangement can be held responsible for their improper actions, not just the entity that actually bills Medicare or Medicaid.

Almost $2 Billion Recovered by DOJ in 2015

In separate reports, the DOJ indicated that it had recovered more than $1.9 billion in settlements and judgments from civil cases involving fraud and false claims against federal healthcare programs, such as Medicare and Medicaid, during 2015.

Have You Been Contacted Regarding an Alleged Federal Fraud Law?

Are you an ambulance service or specialist such as a cardiologist, and are under investigation for alleged fraud related to Medicare billing or other alleged violation of the federal fraud laws? The Criminal Defense Firm has successfully represented clients in all sorts of federal fraud proceedings, including the Anti-Kickback Statute and the Stark Law. Located in Dallas, Texas, The Criminal Defense Firm is a team of lawyers and courtroom warriors. The firm has the resources to provide the best defense possible. If you choose to work with us, we will use our decades of experience, including time spent as federal prosecutors, to help protect your vital interests. To start building your defense today, call 866-603-4540 or contact us online now.

Not all attorneys of The Criminal Defense Firm are licensed in California and nothing contained in here is meant to constitute the unauthorized practice of law.
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