Ambulance Fraud

Houston Ambulance Fraud Attorney

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.

Violating Ambulance Transport Guidelines

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:

  • Other transportation methods were contraindicated by the patient’s medical condition
  • The level of services provided and billed to Medicare were warranted by the patient’s medical condition

Ambulance services that satisfy both of these criteria are medically necessary under Medicare guidelines and allow the provider of the services to be paid.

Ambulance Billing Schemes

  • Billing for higher levels of service than was actually provided furnished to the patient. For example, changing the code of a basic life support ambulance transport can result in an invoice for advanced life support services that were never provided.
  • Billing for services and supplies other than those actually provided. For example, if your company transported a patient, but also billed Medicare for oxygen or monitoring services that were not provided, this could violate the law.
  • Anti-kickback violations in which your ambulance company offers to transport patients at lower than usual costs in exchange for referrals of ambulance transport services from hospitals and nursing homes.

Consequences of EMS Fraud in Texas

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.

Houston Hospital Fraud Defense

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.

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