Ambulance Companies Pay $595,000 to Settle Allegations of Medically Unnecessary Ambulance Transportation
Deirdre M. Daly, United States Attorney for the District of Connecticut, announced that EFK OF CONNECTICUT, INC., d/b/a NELSON AMBULANCE SERVICE, located in North Haven, and SKMP ENTERPRISES, INC., d/b/a ACCESS AMBULANCE SERVICE, located in Bridgeport, have entered into a civil settlement agreement with the government in which they will pay $595,000 to resolve allegations that they improperly billed the Medicare and Medicaid programs.
The government alleges that NELSON AMBULANCE SERVICE (“NELSON”) and ACCESS AMBULANCE SERVICE (“ACCESS”), routinely billed for non-emergency, scheduled ambulance services that were not medically necessary. The medically unnecessary ambulance services were provided to Medicare and Medicaid beneficiaries being transported to and from their regularly scheduled dialysis treatments. Patients transported by NELSON and ACCESS were typically picked up at their residences or at nursing homes and transported by ambulance to and from dialysis treatment three times per week.
Relevant regulations indicate that medical necessity for ambulance transport is established when the patient’s condition is such that the use of any other means of transportation is contraindicated. The regulations indicate that the patient must be “bed confined” or otherwise have a medical condition such that transportation by ambulance is medically required.
The government alleges that NELSON and ACCESS, which have the same ownership, regularly transported patients by ambulance, at an average cost of approximately $380 for each round trip, when the patients did not meet the criteria of being “bed confined” or otherwise have a medical condition requiring transportation by ambulance. Some of the same patients NELSON and ACCESS regularly transported by ambulance were transported to and from other doctor’s visits utilizing a wheelchair van, at an average cost of only $60 for each round trip.
To resolve their liability, NELSON and ACCESS will pay $595,000 for conduct occurring between January 2008 and August 2013.
In entering into the civil settlement agreement, NELSON and ACCESS did not admit liability.
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation. The case is being prosecuted by Assistant U.S. Attorney Richard M. Molot and Auditor Kevin Saunders.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.