Consumer Fraud

Maine Ambulance, Hospital Settle False Claims Act Allegations

ambulance Wikipedia 313x210 Maine Ambulance, Hospital Settle False Claims Act AllegationsA False Claims Act lawsuit brought by the U.S. government against a Maine ambulance company and hospital has been settled, with the defendants agreeing to pay a combined total of more than $1.4 million to end a dispute over what government officials deemed to be unnecessary ambulance rides and other alleged practices costly to Medicare.

Halsey Frank, the U.S. Attorney for the District of Maine, said North East Mobile Health Services of Scarborough, Maine, will pay $825,000 to the U.S. to resolve the False Claims Act allegations, while Maine Medical Center of Portland, Maine, will pay $600,000 in a separate agreement.

North East Mobile’s settlement resolves allegations that it violated the False Claims Act by billing Medicare for non-emergency ambulance transportation provided to patients discharged from Maine Medical Center.

According to federal prosecutors, North East Mobile “falsely claimed” that many Medicare patients it transported were “bed-confined” or in some other state that required transport by ambulance. The government said that the alleged activity started in 2007.

The False Claims Act suit also included allegations that North East also knowingly kept Medicare overpayments.

The Maine Medical Center settlement resolves allegations that its personnel provided North East with statements containing incomplete or inaccurate information about the medical necessity of ambulance rides for Medicare beneficiaries. The U.S. alleges that North East then used this information to bill Medicare.

Both North East and Maine Medical Center strongly denied the allegations in statements to MaineBiz.com. The health care providers said they were always working with the patient’s needs in mind and that they agreed to settle to avoid the legal costs of a drawn-out case.

The U.S. Attorney’s office did not say how the False Claims Act case against both defendants was initiated. The federal government makes most of its False Claims Act recoveries through whistleblowers who file suit under the Act’s qui tam provisions, which permit private parties to sue on behalf of the government.

The U.S. Department of Justice also operates a Medicare Fraud Strike Force, which operates in several major cities and looks for telltale signs of fraud committed against government health care programs.