The companies and their president, Steve Zakheim, were originally investigated for billing Medicare for transports that were not medically necessary. Under Medicare rules, ambulance companies may bill for these expensive non-emergency transports only if the patient could not be transported by any other means, such as by car or by wheelchair van. Medicare audited the companies’ past billings and concluded that the companies had charged Medicare tens of millions of dollars for ambulance trips that did not meet this standard, according to the release.
Medicare then demanded the companies return millions of dollars they had been paid for medically unnecessary ambulance trips. However, the suit alleged instead contesting the charges or returning the payments, the companies forged letters purported to come from healthcare providers attesting the need for ambulance transport in order to keep Medicare payments paid out for certain cases. According to the suit, the company and its president caused the use of hundreds of forged letters purported to come form neutral healthcare providers attesting for the necessity of the ambulance services.
The allegations were originally brought forth in a qui tam suit by a former CFO for one of the companies, which were later intervened by the United States.
Read the DOJ’s release on the New York ambulance false claims scheme.
