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Common Schemes of Transportation Fraud
Common Medicare and Medicaid fraud schemes associated with transportation and ambulance companies involve submitting claims for transporting patients to a hospital when the patients are really taken to other facilities for which claims are non-reimbursable. Other schemes include billing singly for patients who were transported as a group and for falsely claiming reimbursement for ambulatory patients. Examples of Transportation Fraud ♦ An ambulance company agreed to pay $2.1 million to settle allegations that it submitted claims for ambulance transports not covered by Medicare or Medicaid. From September 1991 through July 1997, the company allegedly used its ambulance to transport Medicare and Medicaid beneficiaries to and from their residences and nursing homes for scheduled medical appointments or routine hospital visits. The company improperly represented these transports as medically necessary and as provided to patients who could only be moved by stretcher. As part of the settlement agreement, the company also entered into a three-year corporate integrity agreement. ♦ The former president of an ambulance company agreed to pay the government $325,000 for his role in a scheme through which the company billed Medicare for medically unnecessary trips and non-covered trips to doctors' offices. He was sentenced to more than a year in jail, three years probation, a $250,000 fine, and payment of $1,243 in restitution. The company previously agreed to pay the government $5.4 million to settle allegations of "ticket managing." ♦ Three hospitals agreed to pay $8.7 million to settle allegations relating to the hospitals' inclusion of certain management fees for ambulance services on its cost reports. The allegations claimed that the fees paid to the ambulance management companies were not reasonable and not entirely related to patient care. As part of the settlement agreement, the parent company of the hospitals agreed to enter into a comprehensive five-year corporate integrity agreement.
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