Category Archives: Uncategorized

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 ...

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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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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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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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New Medicare Fraud Strike Force Activity Leads to Charges for Large California Ambulance Service; Houston Mental Health Facility

The United States Department of Justice today unveiled charges against a total of 91 individuals in 7 different locations for allegedly fraudulent activities that allegedly cost Federal healthcare programs in excess of 535 million dollars. The highlights for EMS providers and Texas: Alpha Ambulance Inc. (Los Angeles, CA): Approximately $49.2 million in fraudulent billing ...

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HHS OIG Issues Advisory Opinion Regarding ALS Billing by BLS Ambulance Companies

The Department of Health and Human Services Office of the Inspector General issues an new advisory opinion today, No. 12-12, which addresses the billing of ALS services by a BLS level ambulance service.  The opinion, signed by Greg Demske (full disclosure: I know Greg personally from the ABA ...

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Trailblazer-Novartis Transition News: EFT Enrollees Need to Pay Attention to Mail to Avoid Payment Issues

Novartis has circulated an email warning Medicare providers in the MAC regions currently covered by Trailblazer that they need to pay attention to the mail regarding an issue with Electronic Funds Transfer.  Apparently, Novartis is required to obtain updated Authorization Agreements for EFT's during the transition, and if they don't receive ...

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