The owner of a Kentucky ambulance company has filed a False Claims Act lawsuit in federal court against a competitor company, alleging it routinely bills Medicare for ambulance trips that aren’t medically necessary and engages in kickback schemes designed to drive up profits.
In the complaint, Darrell Stephen McIntosh, owner of McIntosh Ambulance Services, accuses Arrow-Med Ambulance and its owner Hershel Jay Arrowood of pressuring paramedics and emergency technicians to exaggerate the medical conditions of patients so that it could bill Medicare for the rides.
“Arrowood has a car lot and sells flooring, but got into the ambulance business in 2012,” the Lexington Herald Leader reported, citing the lawsuit.
According to the complaint, Arrow-Med regularly transports patients to clinics for dialysis treatments, allowing patients to ride up front with the driver and walk into the clinic on their own.
Mr. McIntosh claims his knowledge of the ambulance business and community positions him to observe the alleged Medicare fraud, which he claims cheats taxpayers and unfairly challenges his business. Mr. McIntosh claims he witnesses dialysis patients doing things such as driving, walking around, and pumping gas, indicating they are not in need of an ambulance ride to the clinic.
According to the suit, Mr. McIntosh “has personally witnessed a number of Arrow-Med’s patients transported to kidney dialysis centers were able to walk outside for the purpose of smoking cigarettes, demonstrating the lack of medical necessity” for ambulance services.
The whistleblower complaint also claims that Arrow-Med billed the government for services that weren’t eligible for reimbursement because the EMT who provided them had a suspended license.
Arrow-Med also violated federal anti-kickback laws by entering into a scheme with a Jackson, Ky., nursing home by providing the home with substantial discounts on ambulance services in exchange for patient referrals, the lawsuit claims.
Mr. McIntosh filed the complaint under the whistleblower provisions of the False Claims Act, which authorize private parties to sue on behalf of the U.S. government and share a percentage of any recovery.
Mr. McIntosh seeks penalties of $11,000 per false claim and legal expenses. Any recovery the lawsuit brings automatically triples under the False Claims Act.
The U.S. government chose to intervene in the case, indicating federal prosecutors found evidence substantiating Mr. McIntosh’s allegations.
Source: Lexington Herald Leader