Kusserow’s Corner: Multi-Million Dollar Ambulance Fraud

I related in my recent blog that the HHS Office of Inspector General (OIG) issued a report (OEI-09-12-00350) on utilization of Medicare Ambulance Transport. They noted that Medicare Part B payments for ambulance transports have grown at a much faster rate than all Medicare Part B payments. They also referenced a number of past reports citing the vulnerabilities to fraud for ambulance transport under Medicare. I concluded that the study suggests a continued interest by the OIG in emergency transportation and would likely lead to some targeted audits and investigations. The day after submitting this blog, the OIG announced an indictment was unsealed charging Superior EMS Ambulance Company, operating from Huntingdon Valley, PA, its owner, Beana Bell and operator Vadim Fleshler, both of Philadelphia, with conspiracy to commit health care fraud. According to the indictment, the case involves a scheme in which the defendants submitted more than $4.4 million in fraudulent claims to Medicare. The defendants were also charged with making false statements in connection with health care matters. These charges parallel some of the fraudulent practices cited by the OIG in their report.

The indictment alleges that the defendants conspired to defraud Medicare by recruiting patients who were able to walk and could travel safely by means other than ambulance and who, therefore, were not eligible for ambulance transportation under Medicare requirements. It is alleged that the defendants, and others acting on their behalf, falsified reports to make it appear that the patients needed to be transported by ambulance when the defendants knew that the patients could be transported safely by other means and that many of them walked to the ambulance for transport. It is further alleged that the defendants themselves, or through others, paid illegal kickbacks to the patients as part of the scheme. The defendants allegedly billed Medicare for these ambulance services as if those services were medically necessary and, as a result of the allegedly fraudulent billing, the Medicare program sustained losses of more than $2.4 million for this medically unnecessary method of transportation.

Once again, these are reminders that the annual work plan of the OIG and the resulting reports are telegraph future enforcement actions by the OIG.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on Google+ or LinkedIn.

Copyright © 2013 Strategic Management Services, LLC. Published with permission.