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Ambulance Fraud

Frohsin Barger & Walthall Handles Ambulance Fraud Cases Nationwide.

Under Medicare “Part B” – Supplementary Medical Insurance for the Aged and Disabled – Medicare covers medically necessary ambulance services. Ambulance services are deemed medically necessary “if they are furnished to a beneficiary whose medical condition is such that other means of transportation are contraindicated.” 42 C.F.R. § 410.40. Although “bed-confinement” is itself neither sufficient nor required as evidence of medical necessity, it is a “factor to be considered.” A Medicare beneficiary is bed-confined if three requirements are met: “(i) the beneficiary is unable to get up from bed without assistance; (ii) the beneficiary is unable to ambulate; (iii) the beneficiary is unable to sit in a chair or wheelchair.”

“Our office is grateful to the law firm of Frohsin Barger & Walthall. Our country needs those with knowledge about the fraud and false claims to realize that if they bring these injustices to our attention, we will diligently work to cure the injustice.” – George L. Beck, U.S. Attorney for the Middle District of Alabama

Medicare imposes an additional requirement for non-emergency, scheduled, repetitive ambulance services, such as dialysis transport. In addition to itself determining that medical necessity requirements are met, the ambulance service provider must, before providing service, obtain a written order from the patient’s physician certifying the medical necessity of ambulance transport. 42 C.F.R. § 410.40(d). Such an order is valid for 60 days.

Effective April 1, 2002, the Centers for Medicare and Medicaid Services established a fee schedule for ambulance services, replacing the previous “reasonable charge” billing procedure. 42 § C.F.R. 414.601. The fee schedule defines several different levels of ambulance service. Payment is made on the basis of services actually performed, rather than on the type of call or vehicle involved. For example, Basic Life Support (BSL) is defined as “transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services.” Accordingly, ambulance providers are required to maintain all records demonstrating the medical necessity of transport services billed to Medicare or Medicaid, as well as the actual provision of a level of service requiring an ambulance.

Frohsin Barger & Walthall has Investigated and Uncovered the Following Types of Medical Transport Fraud:

  • False billing for ambulance service to patients who are not bed-bound or otherwise in need of transport by ambulance
  • False records reflecting fictitious patient conditions intended to justify unnecessary ambulance service
  • False records indicating health services – such as oxygen – that were not provided
  • False billing for individual transport when transport was in fact provided on a group basis
  • False billing for ambulance services that were never provided
  • Illegal kickbacks to nursing homes and assisted living facilities in exchange for referrals of dialysis patients
  • Illegal kickbacks to and fraudulent recruiting of Medicare and Medicaid patients for medical transport services

Our Attorneys are Oft-Cited False Claims Act Academics and National Qui Tam Trial Lawyers.

Jim Barger and Elliott Walthall are the only private attorneys general in the country ever to be tapped as part of a Department of Justice trial team in a Medicare fraud jury trial. A noted expert on the False Claims Act (FCA), Jim Barger teaches upper-level courses on the subject as an adjunct professor at the University of Alabama School of Law, ranked among the nation’s top 15 law schools by Business Insider in 2016. Barger has appeared on HuffPost Live, Fox 6 Atlanta, and National Public Radio. His opinions on FCA Medicare enforcement are regularly sought by major newspaper outlets, including The New York TimesThe Washington Post, and The Birmingham News.

“The Accomplishments of Frohsin Barger & Walthall warrant the wealth of accolades that it has received.” – Benchmark Plaintiff

Both Barger and Walthall have spoken on national panels about Medicare fraud for the American Bar Association, the American Association for Justice, and Taxpayers Against Fraud. In 2015, Barger was a featured symposium speaker on Medicare Fraud and the FCA at the Georgetown Law Center in Washington, DC. In 2016, Georgetown’s American Criminal Law Review published a new research article by Barger on the public-private partnership of the FCA. In 2012, Barger and Walthall won the first ever FCA ambulance fraud whistleblower settlement in the history of Alabama; they have since brought numerous such cases and represent whistleblowers nationwide.

“Frohsin Barger & Walthall Wins $5.4 Million Ambulance Fraud Settlement for Whistleblower and Taxpayers”

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Frohsin Barger & Walthall Represents Whistleblowers Nationwide.

Frohsin Barger & Walthall investigates and litigates qui tam actions on behalf of whistleblowers in federal and state actions across the country. Our representation includes evaluating, investigating, and filing qui tam actions, as well as assisting prosecutors and investigative agents in pursuing cases and reaching settlements, with a high percentage of our cases resulting in government intervention. We have sealed cases in every region of the country and regularly travel to meet with United States Attorney’s offices, State Attorney General Offices, and United States Department of Justice attorneys in Washington, DC.

The False Claims Act Offers Protection for Whistleblowers.

Blowing the whistle on corporate fraud takes courage, and the law rewards that courage with certain protections. We understand that one of the most important aspects of representing corporate whistleblowers is guiding and protecting them through the difficult, stressful process of litigation. The False Claims Act (FCA) provides for a whistleblower’s case to be filed under seal and the identity of the whistleblower to be protected during the course of the government’s investigation. Further, federal laws protect against retaliation by mandating the reinstatement of wrongfully fired employees at the same seniority level, as well as an award of double back-pay, interest, and attorneys’ fees. Finally, successful whistleblowers are entitled to up to 30% of any FCA recovery, which Congress has mandated is three times the amount of fraud that is proved through the whistleblower’s allegations, plus substantial civil penalties.

Frohsin Barger & Walthall whistleblower cases have been featured in the following media outlets, among others:

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