The United States has partially intervened and today filed a complaint in a federal whistleblower lawsuit against Rural/Metro Corporation, Rural/Metro of Central Alabama, Inc., and Mercury Ambulance Service, Inc., doing business as Rural/Metro Ambulance, announced U.S. Attorney for the Northern District of Alabama Joyce White Vance.

Rural/Metro Corporation, through its subsidiaries and affiliates, is engaged in the business of providing medical transportation services to individuals, including ambulance transportation services to Medicare and Medicaid beneficiaries, in approximately 20 states.

Carl Crawley, a former employee of Rural/Metro of Central Alabama, Inc., originally filed the qui tam lawsuit on Sept. 10, 2009, in U.S. District Court for the Northern District of Alabama. In the original complaint, Crawley alleged that Rural/Metro Corporation and Rural/Metro of Central Alabama, Inc., violated the False Claims Act by submitting false claims for ambulance services that were never provided and were medically unnecessary. The United States filed a motion to partially intervene in this action on March 11, 2011. The government’s motion was granted on March 14, 2011. On March 31, 2011, the United States filed a complaint alleging that from Sept. 11, 2003, to the present, the defendants submitted false claims for transportation services provided to dialysis patients.

Medicare’s regulations cover the reimbursement of certain ambulance services only if such services are furnished to a beneficiary whose medical condition is such that other means of transportation are not advised. This generally means that ambulance transportation is appropriate if the beneficiary is bed-confined or if the beneficiary’s medical condition, regardless of bed confinement, is such that transportation by ambulance is medically required. Each state’s Medicaid regulations contain similar provisions.

The United States’ complaint alleges that the defendants created and/or submitted documentation that falsely represented that a patient was either bed-confined or that transportation by ambulance was otherwise medically required. However, many of those patients were neither bed-confined nor needed to be moved on stretchers, and did not require ambulance transportation or qualify for ambulance transport under the applicable Medicare or Medicaid requirements.

“The defendants’ submission of false claims to Medicare and Medicaid resulted in unnecessary expenditures from these programs” Vance said. “The United States intends to aggressively pursue the recovery of the Medicare and Medicaid funds improperly obtained by the defendants in this case.”

The allegations in the complaint do not relate to the quality of the care provided by the defendants during the transportation.

The lawsuit was filed under the qui tam provisions of the False Claims Act, which permit private parties to sue on behalf of the United States when they believe that defendants submitted false claims for government funds. The private plaintiffs are called “relators,” and, under the statute, are entitled to receive a share of any funds recovered through the lawsuit. The False Claims Act permits the government to recover three times its damages plus civil penalties.

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $5.5 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $7.1 billion.

Assistant U.S. Attorney Lloyd Peeples is the government’s lead attorney on the case. The investigation is being handled by the Office of the Inspector General of the Department of Health and Human Services.

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ORIGINAL SOURCE: U.S. ATTORNEY’S OFFICE — NORTHERN DISTRICT OF ALABAMA

The original whistleblower complaint on behalf of qui tam relator Carl Crawley, was filed by Frohsin & Barger. To report Medical Transport fraud or other Medicare or Medicaid fraud, contact Frohsin & Barger.