The Williston Rescue Squad has agreed to pay the United States $800,000 to resolve allegations that it violated the False Claims Act by making false claims for payment to Medicare for ambulance transports, the U.S. Department of Justice announced this week.
The settlement resolves allegations that the Williston Rescue Squad billed Medicare for routine, non-emergency ambulance transports that were not medically necessary, and that Williston created false documents to make the transports appear to meet the Medicare requirements, the Department of Justice said in a statement.
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.
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 the statement.
Under the False Claims Act qui tam – or “whistleblower” – provisions, private citizens can bring suit on behalf of the United States and share in any recover.
The whistleblower in this case will receive $160,000 as her share of the government’s recovery.
In 2011, the government identified various billing concerns at the Williston Rescue Squad that arose from claims submitted from the Rescue Squad’s transport division from 2008 to 2011, according to Phil Clarke, director of the Williston Rescue Squad. These claims related primarily to the transportation of dialysis patients.
“Once these concerns were identified, Williston fully cooperated with the government, which resulted in a settlement agreement in which there was no admission of liability by Williston,” Clarke said in a statement. “However, to resolve the government’s concerns and to bring closure to the process, Williston agreed to make certain payments to the government. Williston is committed, more than ever, to serving the community of Barnwell and has emerged from this incident a stronger and more focused company concentrating on what it has always done best, emergency medical services.”
U.S. Attorney Bill Nettles said Medicare fraud is “crippling” the country’s health care system.
“We have doubled the number of attorneys working these cases in South Carolina,” he said in a statement. “Take notice, if you are bilking the Medicare system designed to support our elders, we are working to find you.”
Nettles implored “honest service providers” to report fraud at 1-800-MEDICARE.
This resolution is part of the government’s focus on combating health care fraud.
The Health Care Fraud Prevention and Enforcement Action Team initiative, which is a partnership between the Department of Justice and the Department of Health and Human Services begun in 2009, focuses efforts on reducing and preventing Medicare and Medicaid fraud through enhanced cooperation, according to the statement.
The False Claims Act has been used to recover nearly $10.2 billion since January 2009 in cases involving fraud against federal health care programs.