A whistleblower was instrumental in helping the U.S. recover $1.2 million in federal health care funds from a Jacksonville, Florida-based ambulance company, the U.S. Attorney in Orlando said.
Liberty Ambulance agreed to pay the $1.2 million to resolve allegations that it overbilled Medicare, Medicaid, and other taxpayer-funded health care programs for transporting patients. Liberty knowingly up-coded claims for life-support services from “basic” to “advanced” without justification, according to the whistleblower lawsuit.
The complaint also alleged that Liberty billed Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program for unnecessary patient transportation. The alleged activity occurred between June 2005 and January 2016, federal prosecutors said.
The case against Liberty Ambulance was part of a broader, multiyear investigation involving several other defendants. In May 2015, the U.S. Department of Justice acknowledged it had investigated allegations against Liberty Ambulance but said at the time it was unable to reach a settlement with the company. The Justice Department added that it would continue to pursue its claims and file a civil complaint against Liberty in the future.
The settlement was the result of a lawsuit filed by Shawn Pelletier, a former employee of Liberty Ambulance. Mr. Pelletier filed the complaint under the whistleblower provisions of the False Claims Act, which allows private parties to sue on the government’s behalf in cases of suspected fraud.
Whistleblowers whose False Claims Act lawsuits lead to a recovery for the U.S. are awarded a percentage of the total settlement or judgment. Mr. Pelletier will collect about $264,000 of the $1.2 million Liberty settlement as his award on top of $1.2 million in whistleblower awards he collected after prior settlements.
“When health care providers participate in fraudulent billing schemes in order to increase profits, they steal from the pockets of the taxpayer and jeopardize federal health care programs,” said Shimon Richmond, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “We will continue to be relentless in our efforts to hold such providers accountable.”