Reduction of fraud and abuse remains a focus of the government’s efforts to ensure providers accountability. Recently, the Department of Justice (DOJ) announced a $3.199 Million settlement of alleged False Claims Act violations resulting from an ambulance “swapping” arrangement between a skilled nursing home and ambulance service (Regent settlement). Once again, the Department of Justice news release announced that another ambulance provider came under the scrutiny of the Medicare Fraud Strike Force (HEAT), a joint effort of the FBI and HHS-OIG. The Department of Justice announced the prison sentences for the owner, operator and managers of ProMed Medical Transportation, a Southern California ambulance company, as a result of a Medicare fraud scheme involving fraudulent billing for ambulance services. The ambulance company conspired to bill Medicare for transportation that was not necessary, and had the paperwork altered to conceal the patients’ true medical conditions to create fraudulent conditions to justify the services. In addition to the prison sentences ranging from 24 months up to 108 months, the convicted billing manager and supervisor were ordered to pay restitution jointly and severally in the amount of $804,755.
HEAT is serious about increasing accountability and decreasing the presence of fraudulent providers. Ambulance operators are clearly in the eye of HEAT. Other healthcare providers should also take note as sentences and restitution are serious consequences. Healthcare providers need to be aware and conscious of their operations to ensure that they do not fall under the scrutiny of HEAT. As the Regent settlement and the convictions discussed above demonstrate, HEAT is committed to its fight against fraud and abuse.
By Denise Bloch