U.S. Attorney’s Office settles with individuals in Medicare fraud case

TEDDY KULMALA

Posted: Thursday, June 27, 2013 8:43 p.m. 
UPDATED: Friday, June 28, 2013 9:06 a.m.

The U.S. Attorney’s Office announced on Thursday that the government has reached settlements with three emergency medical technicians and one paramedic regarding allegations they assisted the Williston Rescue Squad in defrauding Medicare.

The four employees allegedly defrauded Medicare by transporting patients who clearly did not need ambulance transport for weekly dialysis treatments, according to a statement from U.S. Attorney Bill Nettles. The settlements ranged from $2,000 to $5,000 and were based on the individual’s ability to pay.

The District of South Carolina has been investigating the unnecessary transportation of dialysis patients for several years and has settled with numerous offending ambulance companies; however, this is the first time line individuals who assisted in the transports and created false records to support medical necessity have been the subject of an investigation. In this case, the individuals documented the patients were transported by stretcher when they walked to the ambulance.

Medicare only reimburses providers for non-emergency ambulance transports if the patient transported is bed-confined or has a medical condition that requires ambulance transportation.

Nettles said Medicare pays about $50,000 a year for ambulance transportation of one dialysis patient. “When it is medically necessary, ambulance transportation is appropriate,” he said. “But when it is not, it is fraud and could not be perpetrated without the assistance of these licensed individuals.”

The Williston Rescue Squad in February agreed to pay the United States $800,000 to resolve allegations that it violated the False Claims Act by making the false claims for payment to Medicare.

The settlement revolved around a lawsuit filed by a clinical social worker at a facility that regularly received patients transported by Williston’s ambulances, according to previous reports. The “whistle-blower” in that case received $160,000 as her share of the government’s recovery.

Teddy Kulmala covers the crime beat for the Aiken Standard and has been with the newspaper since August 2012. He is a native of Williston and majored in communication studies at Clemson University.

http://www.aikenstandard.com/article/20130627/AIK0101/130629554/1008/AIK0102/us-attorney-x2019-s-office-settles-with-individuals-in-medicare-fraud-case