Ambulance Fraud

The singular most common fraudulent billing scheme committed by any ambulance company is charging someone for an unnecessary medical dialysis transport.  In general, those who undergo dialysis require treatment several times a week and, therefore, can unknowingly make themselves very "profitable" customers at the expense of taxpayers.

Some frequent types of ambulance fraud consist of:

• Unnecessary medical transports that are billed to Medicare or Medicaid.  For example, habitual transportation of dialysis patients and those requiring radiology.
• Requiring payment for services and/or supplies that were not provided or were otherwise not medically necessary.

In order to be paid by Medicare or Medicaid, an ambulance transport claim must be medically necessary—a term which is defined by federal law.  Federal law has two criteria that need to be met in order for services and procedures to be “medically necessary” which are:

• The use of other methods of transportation is contraindicated by the patient’s condition, and,
• The patient’s medical condition must justify the amount of services allegedly performed and billed.

Transportation that fails to meet this criteria is not considered a covered benefit and is therefore ineligible for reimbursement.  Ambulance companies that deliberately submit a claim for any ineligible transport is guilty of submitting a false claim to the government which can be reported by a whistleblower through the qui tam provisions of the False Claims Act.

Egan Young attorneys have worked on numerous ambulance fraud cases under the False Claim Act and, as such, have unique experience and expertise in this area.  If you or someone you know has information about ambulance fraud, contact Egan Young today for a free confidential consultation.