Kusserow’s Corner: Another Ambulance Service Owner Convicted for Fraud

On Halloween, Gwendolyn Climmons-Johnson, the owner of Texas-based Ambulance Service was convicted by a federal jury after a three day trial on multiple counts of health care fraud for submitting false and fraudulent claims to Medicare for ambulance services. She was the owner and operator of Urgent Response EMS (Urgent Response) and provided non-emergency ambulance services to Medicare beneficiaries in the Houston area. She and others conspired to unlawfully submit false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and/or not provided in the amount of approximately $2.4 million. At trial, the evidence showed that patient records had been falsified and the Medicare beneficiaries for billings of ambulance services that were not needed and not for the condition stated in the records.

There are many other similar cases that have come to light over the last few months and this is just the latest in a series of cases evidencing increased enforcement efforts involving ambulance fraud. The HHS Office of Inspector General (OIG) issued a report (OEI-09-12-00350) on utilization of Medicare Ambulance Transport that took note of the fact that Medicare Part B payments for ambulance transports is growing at a much faster rate than all other types of payments and cited from previous reports on a number of vulnerabilities to fraud for ambulance transport under Medicare.

This most recent case falls in the category of mischaracterizing the type of service provided and charging Medicare improperly. Other cases often include recruiting patients who were able to walk and could travel safely by means other than ambulance and as such are not eligible for Medicare ambulance transportation; falsifying reports to make it appear that the patients needed to be transported by Ambulance; and payment of illegal kickbacks to the patients.

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.