The US Attorney for the Southern District of Texas and the Texas Attorney General had unsealed a federal indictment against a South Texas ambulance company owner under the false claims act. In addition to the charges of health care fraud, there were also charges of aggravated identity theft and mail fraud (either this or wire fraud tend to be added to most indictments – the elements of mail fraud are easy to prove because it only involves making a misrepresentation in a document sent by mail).
There is intense pressure on ambulance services in Texas to both compete and skirt the statutes and rules associated with Medicare and Medicaid. Not knowing all of the details of this case, I can’t comment on the matter specifically, but I know that Houston and the South Texas region are listed as hotbeds of alleged health care fraud and ambulance services need to be aware of the implications.
I have done poorly attended seminars and talked with several ambulance company owners in the last few years about this issue – compliance is the key and if you don’t have a compliance program, one may be pushed upon you by CMS soon. The DOJ/HHS OIG press release for the case above is after the jump.