The Florida Times Union reports that a lawsuit filed here in Jacksonville in federal court could have a nationwide impact. According to the article, a local federal prosecutor has developed a legal strategy that could have hospitals across the country paying the bill for billions of dollars in unnecessary ambulance services. U.S. Attorney A. Lee Bentley III told the paper that a group of Jacksonville hospitals has agreed to reimburse the federal government for ambulance companies’ inappropriate billing despite the hospitals not receiving direct financial gain. The legal strategy allows the government to sue because the hospitals were the cause of the fraudulent billing by calling the ambulance services to take patients from the hospital to their residence and provided the necessary forms to bill federal health care programs. The total amount of the settlement is about $7.5 million. It breaks down as follows: the hospitals will pay the government $6.25 million, and Century ambulance service agreed to pay $1.25 million. The hospitals included in the lawsuit are: Baptist Medical Center Downtown, Baptist Medical Center South, Baptist Medical Center Beaches, Baptist Medical Center Nassau, Memorial Hospital Jacksonville, Orange Park Medical Center, Specialty Hospital Memorial Health, Lake City Medical Center and UF Health Jacksonville. The two largest, private ambulance companies in Jacksonville — Century Ambulance and Liberty Ambulance — also were sued. Even though Century agreed to settle, Liberty did not.
Even though the hospitals and Century settled, they still say they did nothing wrong and they strongly disagreed with the allegations. Regardless, Baptist Medical Center officials believe the organization did nothing wrong and “fundamentally disagree” with the allegations. Baptist agreed to settle to avoid the inconvenience and expense of lengthy litigation. The other hospitals also contend they did nothing wrong. “It is important to note that UF Health Jacksonville did not receive any payments for transportation or ambulance services and did not charge federal payers for any services, which were central to the lawsuit,” the hospital said. …” As a condition of the settlement, UF Health Jacksonville has not admitted to any wrongdoing or violation of applicable laws but has agreed to provide additional guidance and education to employees involved in requesting ambulance services.” HCA Healthcare owns four of the hospitals sued by the federal government — Memorial Hospital, Orange Park Medical Center, Specialty Hospital Memorial Health and Lake City Medical Center. “Our goal is to do what is best for our patients — including post-discharge transport, whether by ambulance or not,” spokeswoman Ilyssa Drumm said. “There are complex Medicare rules that govern the appropriateness of when ambulance companies may bill for such transport if the patient is deemed well enough to travel in a cab or van. This settlement addresses that issue for certain former patients.” The defendants pointed out to the paper that the settlement does include language that the hospitals and ambulance companies do not admit fraudulently billing federal health care programs. The one ambulance group that did not settle, Liberty, states the lawsuit is calling the government’s actions a “federal money grab” that’s bankrupting companies nationwide. Liberty’s president went on to say the federal prosecutor who is working these cases even told him that ambulance billing for federal health care programs is one of the most difficult systems to navigate.
Jason Mehta, an assistant U.S. attorney, began the federal investigation into Medicare fraud by Jacksonville ambulance companies in 2011 after a whistle-blower lawsuit was filed by Shawn Pelletier, an EMT since 1998 who worked for Century from 2004 to 2006 and Liberty from 2007 to 2009. Pelletier said he witnessed documents being falsified for the purpose of billing Medicare or Medicaid during his employment at both companies, according to the lawsuit .Mehta said as he began pulling information from the ambulance companies, he noticed the majority of the non-emergency ambulance rides originated from the hospitals. Most of those rides ended at a nursing home. He said the other most common transport from a hospital in an ambulance ended at the patients’ residences. The next most common destination was to another hospital, Mehta said. He said there are also reasons for a hospital to use an ambulance service to transport a patient home, but when he cross-referenced those rides with available medical records, the U.S. Attorney’s Office deemed the vast majority were not needed. Mehta said although the hospitals didn’t gain financially from billing Medicare, they did gain indirectly by removing patients who had already been treated, allowing for rooms to be filled quicker with new patients.Baptist countered that it is often faster to transport a patient by family, friend or taxi. Mehta said since the U.S. Attorney’s Office lawsuit became public, the expenses of ambulance transport has decreased by one-third in the Jacksonville area and many of the hospitals have began voucher programs for taxi services.
Recently, the U.S. attorney’s offices in South Carolina and New Jersey shut down about a dozen ambulance companies in those states with large settlement agreements. According to the U.S. Attorney’s office, ambulance companies filing fraudulent claims is a nationwide issue.They say while federal health care program expenses are increasing, the rate at which ambulance transport expenses are increasing is about twice the rate of other expenses.