Let’s say you have a dialysis treatment coming up. You could drive
yourself to the clinic. On the other hand, an ambulance company says that
it would be glad to give you a ride – but first, it would like to
pay you cash of $100 to $400 a month.
The federal Government has indicted a Pennsylvania company that allegedly
agreed to do just that. According to U.S. attorneys in that state, Penn
Choice Ambulance, Inc., bilked the federal government of $1.5 million
by charging Medicare for ambulance rides for patients who were going to
dialysis – even though the patients could have gotten there on their
own. Sometimes the company even drove patients in their own cars! Of course,
when Penn Choice wasn’t billing huge amounts to Medicare, those
same patients drove the cars on their own to other places.
I’m an attorney who represents people who know about fraud against
the Government, like
ambulance fraud whistleblowers (also known in the industry as “relators”), and I am seeing
an uptick in the number of cases where whistleblowers report that ambulance
companies are giving rides – at great expense to Medicare –
to people who don’t need them. Whistleblowers who file suit to report
this kind of fraud are entitled to 15% – 30% of what the Government recovers.
According to a Bloomberg News Article,
Medicare’s $5 Billion Ambulance Tab Signals Area of Abuse, Penn Choice Ambulance is not the first company to bilk the government.
In fact, it bought the names and addresses of its clients from Brother
Love, an ambulance provider shut down by the federal government for billing
Medicare for ambulance trips for patients who did not need them. How much
were these names worth? Apparently Penn Choice Ambulance thought they
were worth $2000 per name and address.
Penn Choice Ambulance is not the only company that is taking Medicare for
a ride, according to Health and Human Services (HHS). Medicare is shelling
out a budget-draining $5 billion dollars a year to ambulance companies.
Cancer doctors get less. Orthopedic surgeons get less. And taxpayers,
of course, get way, way less after they pay for needless services.
Pennsylvania Assistant United States Attorney Beth Leahy prosecuted six
cases against ambulance companies, including the one against Penn Choice
Ambulance. She says the scheme is a “cash cow” that is “basically
like a taxi service” – but way more expensive, of course.
Oh – and you, that gullible, endlessly wealthy taxpayer, get the bill.
Fraudsters have settled on trips to dialysis centers as the easiest, most
lucrative channel for ambulance fraud. According to Medpac, the Medicare
Payment Advisory Commission, the Government is funneling $700 million
into rides to dialysis centers. Patients need dialysis three times a week,
indefinitely unless they receive a new kidney. All those rides are easy
pickings for a company bent on stealing money from the federal coffers.
Medicare admits it is paying too much for ambulance care. It says the spending
is distorted by payments in five states where ambulance companies receive
50% more than ambulance operators do in other states. Apparently the five
best states to open your new ambulance company – assuming you are
not real worried about niceties, like honesty — are Massachusetts,
Pennsylvania, New Jersey, South Carolina, and West Virginia. Those states
receive such a big chunk of the total that Medicare claims it could cut
the $700 million it spends on ambulance trips down to $300 million, just
by bringing the charges in those states in line with the average charge
in the other states.
Recognizing that ambulance services are a significant source of fraud,
the Government has sued 12 companies in the last year. The second largest
ambulance provider, Rural/Metro, has paid the Government $8.2 million
to resolve claims that it overbilled.