Health Care Fraud and EMS: McAllen Ambulance Owner Charges with Mulitiple Allegations of Health Care Fraud

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.

Marc

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HHS-OIG Post New Advisory Opinion Related to EMS

The Department of Health and Human Services posted a new advisory opinion today, No. 13-05. It is related to EMS directly in that the question to be answered is would a payment by a private operator to a municipality for dispatch services violate the Anti-Kickback Statute. I think this is actually pretty much a no-brainer absent ...

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Novitas Obviously Does Not Understand Modern EMS

Ok, this gem appeared in my mailbox today. I will have a couple of comments after jump as well, but the problem with this policy bulletin is that it does not take into account what routinely happens in cardiac arrest scenarios, especially in progressive EMS systems.  Specifically, what happens when an ALS ...

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A Very Bad Day for Unionized Texas Firefighters

Holy ****.  That is about all I can say about the opinion handed down by the Texas Supreme Court on Friday in City of Round Rock v. Rodriguez.  If you valued your union representation at investigative interviews, you can likely kiss it goodbye for the time being. In a split decision, with Chief Justice Jefferson and ...

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If at First You Don’t Succeed – Firefighter Terminated for a Second Time

A Mission, Texas Firefighter has been terminated for the second time in a little over 2 years, according to a report posted on Curt Varone's Fire Law blog. The firefighter was fired back in 2010 for a cover-up involving a backing accident that also led to the dismissal of two other firefighters. The current event involved ...

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Novartis Posts Q&A on Effect of Sequestration on Medicare Payments

From my inbox: Sequestration Q&A https://www.novitas-solutions.com/parta/info-alerts.html https://www.novitas-solutions.com/bulletins/all/news-03112013.html ISSUED: (03/18/2013 @ 3:00 PM) Question: Does the 2% payment reduction under sequestration apply to the payment rates reflected in Medicare fee-for-service fee schedules or does it only apply to the final payment amounts? Answer: Payment adjustments required under sequestration are applied to all claims after determining the Medicare payment including application ...

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CMS Ambulance Open Door Forum tomorrow, March 19th, 2013

CMS hosts Open Door Forums on several different topics on a regular basis. For those interested in the EMS business, the Ambulance Open Door Forum can be a valuable source of information, especially related to CMS priorities and thinking on reimbursement issues. The next CMS Ambulance Open Door Forum scheduled for: Date:  Tuesday, March 19, 2013 Start ...

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Novitas Webinar on Ambulance Service Billing – A Must for Ambulance Services and Billing Personnel in Texas and the Other JH States!

From my inbox: Freshen Up This Friday on Ambulance Services January 18, 2013 1:00pm-2:00pm Central Time (CT) Ambulance Services Webinar 1.0 CEU Ambulance Service Providers, be sure to make time this Friday for a very informative webinar! Are you looking to enhance your knowledge on proper billing for your services? If so, attend our event as we review findings from the analysis ...

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CMS releases 2013 Ambulance Inflation Factor – 0.8%

In a new Medicare Learning Network article, the Center for Medicare & Medicaid Services has announced that the Ambulance Inflation Factor (AIF) for2013 will be 0.8%. The AIF is designed to provide a basis for CMS Medicare Administrative Contractors (MAC) and Fiscal Intermediaries (FI) to adjust payment limits. The Affordable ...

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From the DOJ: Ambulance Company Operator in Houston Pleads Guilty to Fraud

A Houston area ambulance service operator plead guilty yesterday to conspiracy to commit healthcare fraud related to over $1.7M in billings for transports connected to "community mental health centers"  If you don't remember, this case sounds very similar to some cases that I have previously

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