If you or your company receives Medicare payments for ambulance transport services that are not medically necessary, you could be charged with emergency medical services fraud. An ambulance company that bills for services it knows to be ineligible for reimbursement might be violating federal law. EMS fraud is a violation of the federal False Claims Act.
Under federal Medicare guidelines, an ambulance company is entitled to be reimbursed for transporting a Medicare patient if the use of the ambulance satisfies both of the following criteria:
Ambulance services that satisfy both of these criteria are medically necessary under Medicare guidelines and allow the provider of the services to be paid.
Billing for medically unnecessary ambulance transport services is one practice that could get you in trouble with federal prosecutors. Other forms of EMS fraud include:
The federal False Claims Act includes large fines and monetary penalties for those caught cheating the government. The law authorizes judges to impose penalties up to triple the amount of the actual amount of the damages suffered by the government. Whistle-blowers reporting acts of fraud to prosecutors are entitled to a share of the penalties imposed upon the wrongdoer.
Consulting with an experienced criminal defense attorney is essential if you have been charged with fraud. Submitting a false bill for services does not mean your company is guilty of fraud. Prosecutors must prove that you knew or should have known that the bill was false to establish fraud under the False Claims Act.
If you have been charged with ambulance fraud and would like to learn more information on the subject, then call Rand Mintzer at 713-862-8880 to set up an appointment to get free legal consultation.