Conn. Ambulance Company Gets Pulled Over for Federal Health Care Fraud

November 4, 2004

Kevin O’Connor, United States Attorney for the District of Connecticut, announced that Professional Ambulance Service of Norwich Inc., also known as P.A.S.O.N., whose business offices are located at One American Way, Norwich, Connecticut, has pleaded guilty to a charge of federal health care fraud.

Professional Ambulance’s plea of guilty was accepted by Senior U.S. District Judge Peter Dorsey in New Haven federal court. Professional Ambulance has also entered into a civil settlement agreement with the United States and the State of Connecticut to resolve its civil liability for allegedly submitting false claims to the Medicare, Medicaid and TRICARE Programs.

When it is sentenced on January 7,2005, Professional Ambulance faces a maximum term of probation of five years and a fine of up to $500,000.

O’Connor explained that this case arose from Professional Ambulance’s non-emergency transportation of Medicare beneficiaries to kidney dialysis treatments from 1999 through 2001. Medicare pays for ambulance transportation of such patients only if the patient is “non-ambulatory,” which Medicare defines as unable to get up from bed without assistance or unable to sit in a chair or wheelchair.

From 1999 through 2001, Professional Ambulance submitted claims to Medicare and TRICARE – a federal program that provides health care to members of the armed services and their families – for transportation of patients by Professional Ambulance and a related company, American Ambulance, when Professional Ambulance reportedly knew that the trips were not covered by Medicare.

In order to obtain payment from Medicare and TRICARE, the company reportedly instructed EMTs and paramedics from not to mention in medical records that a patient could walk, stand, or sit up in a chair. In this fashion, Professional Ambulance was able to obtain payment from Medicare and TRICARE for non-covered ambulance transports.

O’Connor further announced that Professional Ambulance and its affiliated company, American Ambulance of Norwich Inc., have entered into a civil settlement with the Government, in which the companies paid $1,598,040.12 to settle allegations that the companies violated the civil False Claims Act by allegedly submitting false claims to the Medicare, Medicaid and TRICARE programs between 1997 and 2001. The False Claims Act provides for treble damages and penalties of $5,500.00 to $11,000.00 per false claim submitted to the Government.

Professional Ambulance and American Ambulance agreed to pay double damages to resolve their potential civil liability under the False Claims Act. In addition, Professional Ambulance and American Ambulance entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of the Medicare Program.

In entering into the civil settlement agreement, Professional Ambulance and American Ambulance did not admit liability, and the agreement indicates that the parties entered into the settlement to avoid the uncertainty and expense of litigation.

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