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Lawsuit Against Hospitals Sending Patients Home in Ambulances Could Have Nationwide Impact

Hospitals’ liability estimated at billions of dollars

A federal prosecutor in Jacksonville, Florida, has developed a legal strategy that could have hospitals across the country on the hook for billions of dollars in unnecessary ambulance services, according to an article published in the Florida Times-Union and posted on the jacksonville.com website.

U.S. Attorney A. Lee Bentley III said a group of Jacksonville hospitals has agreed to reimburse the federal government for ambulance companies’ inappropriate billing despite the hospitals not receiving direct financial gain.

The legal strategy allows the government to sue because the hospitals were the cause of the fraudulent billing by calling the ambulance services to take patients from the hospital to their residence and provided the necessary forms to bill federal health care programs, according to the U.S. Attorney’s Office.

The total amount of the settlement is approximately $7.5 million. The hospitals agreed to reimburse the government $6.25 million for non-emergency ambulance rides. An ambulance service agreed to pay $1.25 million.

Recently, the U.S. attorney’s offices in South Carolina and New Jersey shut down about a dozen ambulance companies in those states with large settlement agreements.

Jason Mehta, an assistant U.S. attorney, began the federal investigation into Medicare fraud by Jacksonville ambulance companies in 2011 after a whistle-blower lawsuit was filed by an emergency medical technician (EMT).

Mehta said that as he began gathering information from the ambulance companies, he noticed that most of the non-emergency ambulance rides ended at a nursing home. He said the other most common transport from a hospital in an ambulance ended at the patients’ residences. The next most common destination was to another hospital.

Mehta said there are also reasons for a hospital to use an ambulance service to transport a patient home, but when he cross-referenced those rides with available medical records, the U.S. Attorney’s Office deemed the vast majority were not needed.

Mehta said that although the hospitals didn’t gain financially from billing Medicare, they did gain indirectly by removing patients who had already been treated, allowing rooms to be filled more quickly with new patients.

Mehta noted that since the U.S. Attorney’s Office lawsuit became public, the expenses of ambulance transport has decreased by one-third in the Jacksonville area and that many of the hospitals have began voucher programs for taxi services.

Mehta said ambulance companies filing fraudulent claims is a nationwide issue. He said while federal health care program expenses are increasing, the rate at which ambulance transport expenses are increasing is about twice the rate of other expenses.

In fact, this type of ambulance transport — a minimum of $150 per ride — cost the U.S. government $250 million during a 6-month period in 2014, according to Mehta.

Bentley, the U.S. attorney for the Middle District of Florida, said the total hospital liability could be in the billions of dollars as the statute of limitations for this type of crime goes back 6 years.

Source: jacksonville.com; May 2, 2015.

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