NEWS NETWORK By Christopher Kelly
EMSWORLD.com | JUNE 2015 13
Contact us now for a demo at medapoint.com/contact
or speak with an AdvanceClaim expert at (866) 864-7033
ADVANCECLAIM'S SINGLE- CLICK INSURANCE VERIFICATION OPTIONS WILL
MedaPoint's 100% web-based EMS billing solution delivers a radically more ef cient
workf ow and unrivaled simplicity, with a 99% clean claim rate upon f rst submission.
• Enable you to f nd patient insurance and
verify eligibility quickly and in one place, and;
• Avoid the hassle of relying on others to
determine coverage.
• Seamlessly connect you with more than
3,000 government and private payers with
our integrated clearinghouse.
TAKING THE RISK OUT OF EMS BILLING
Now with Intelligent Eligibilit y
™
AdvanceClaim
™
For More Information Circle 14 on Reader Service Card
The U.S. Attorney's office in Jacksonville,
FL, announced a healthcare fraud settle-
ment in March that involved two ambulance
service suppliers and four hospitals.
The case was based on "whistleblower"
lawsuits filed in June 2011 and August 2014
in federal court by a former employee of
both of the ambulance services.
The settlement was reached in March
2015 with all defendants except for one of
the ambulance service suppliers who denies
the allegations. The U.S. Attorney has said
they will pursue the case against the one
ambulance company that has not settled.
The lawsuit alleges that both of the ambu-
lance services altered patient care reports to
meet medical necessity and one required
crews to falsify information such as pulse ox
and EKG readings, while the other ordered
EMTs to omit all positive findings that would
prevent trips from being reimbursable.
The hospitals are accused of falsifying
patient conditions on physician's certifica-
tion statements (PCS forms) in order to get
patients transported by ambulance who
could have traveled by other means.
While this is certainly not the first time
an ambulance service has been accused of
fraud, this is the first time I am aware of that
the government has pursued the PCS issue
against the person or entity who signed it.
This should give pause to hospitals or physi-
cians who routinely misuse EMS by ordering
discharge transport by ambulance when it is
not medically necessary. However, this may
also cause them to refuse to sign even when
transport is justified due to the potential
liability created by signing the PCS.
For more information or to see copies of
the actual lawsuits, go to www.news4jax.
com/news/ambulance-fraud-lawsuits-name-
4-area-hospitals/31928530.
Some of the details of this settlement have
now been released. The hospitals are paying
the vast majority of the settlement amount.
Out of the total settlement of $7.5 million,
the four hospitals are paying $6.25 million.
The one ambulance service has agreed to
pay back $1.25 million. The U.S. Attorney's
office has stated that they have developed
a strategy for going after the hospitals even
though they do not directly benefit finan-
cially from the ambulance reimbursement.
Of course, this new position from the U.S.
Attorney's office may have a chilling impact
on hospitals' willingness to sign PCS forms
nationwide.
Christopher Kelly is a lawyer who focuses on
regulatory healthcare law as it relates to the EMS and
ambulance industry. This article is not intended as
legal advice. For more information or questions, he
can be reached for a free initial consultation at EMS
Consultants, Ltd., 800/342-5460 or e-mail ckelly@
emscltd.com.
One Ambulance Service, Four Hospitals Settle Fraud Case