U.S. Attorney Leonard C Boyle, Special Agent in Charge Phillip Coyne of the U.S. Department of Health and Human Services, Office of Inspector General, and Connecticut Attorney General William Tong today announced that AMERICAN MEDICAL RESPONSE OF CONNECTICUT, INC. (“AMR”), has entered into a civil settlement agreement with the federal and state governments and has paid $601,759 to resolve allegations it submitted improper claims to Medicare and Medicaid for ambulance services. AMR is an ambulance company operating in Connecticut.
There are various types of services related to ambulance billing. Advanced Life Support services (“ALS”) include services performed by a paramedic at the scene of an emergency response and in the ambulance. ALS services require a high level of medical monitoring. Basic Life Support services (“BLS”) are lower acuity services that can be performed by an emergency medical technician-basic, or relate to the transport of the patient in the ambulance to a hospital or other medical facility. In several towns in Connecticut, local fire departments provide ALS emergency services when a 911 call is dispatched. AMR is also dispatched to the scene of these calls to provide ambulance transport only (a BLS service). When the fire department and AMR are on the scene together, it is a “joint response.”
The federal and state governments allege that AMR would often bill Medicare and Medicaid for ALS (paramedic) services when it was only providing the BLS (ambulance transport) services.
For claims submitted to Medicare, billing for ALS services in “joint response” situations would have been proper if AMR had a written billing agreement in place with the local fire departments, which it did not during relevant time period. For claims submitted to Connecticut Medicaid, in many cases, both AMR and the local fire departments billed Medicaid for ALS/paramedic services. As a result, Medicaid actually paid twice for the paramedic services, once to the local fire departments and a second time to AMR.
To resolve the governments’ allegations, AMR paid $601,759, which covers claims submitted to the Medicare and Medicaid from January 2014 through December 2019.
AMR also entered into a consent agreement the with the Connecticut Department of Public Health in which they agreed to cease and desist the prohibited conduct and to pay a $25,000 civil penalty to the State of Connecticut.
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services and the Connecticut Office of the Attorney General. The case is being prosecuted by Assistant U.S. Attorney Richard M. Molot, and Assistant Attorney General Karla Turekian of the Connecticut Office of the Attorney General.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.