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California Ambulance Fraud Attorney

When a person suffers a serious medical emergency, an ambulance is often the preferred method of transit to the hospital. However, ambulance services cost money, resulting in expensive payouts by insurance companies. While the Medicare program pays for various types of ambulance service for its beneficiaries, including traditional ground-based ambulances and air ambulances, ambulance fraud against Medicare and other publicly-funded health programs is widespread. If you have evidence of ambulance fraud being perpetrated against any government program, please contact a California ambulance fraud attorney, as you may be able to assert a claim under the False Claims Act.

Medicare Regulations for Ambulances in California

The Medicare program reimburses ambulance providers for necessary services on behalf of their beneficiaries. The program provides payment for these services only under the following conditions

  • Actual transportation of the beneficiary occurs
  • The beneficiary is transported to an appropriate destination
  • The transportation by ambulance is medically necessary (i.e., the beneficiary’s medical condition is such that other forms of transportation will not suffice)
  • The ambulance provider meets all applicable, vehicle, staffing, billing, and reporting requirements

The program also reimburses air ambulance providers (both rotary-wing and fixed-wing) for transportation services to hospitals, but not other destinations, such as a skilled nursing facility, a doctor’s office, or the patient’s home. Such services are available only for the following medical emergencies

  • Intracranial bleeding requiring neurosurgical intervention 
  • Cardiogenic shock
  • Burns requiring treatment in a burn center
  • Conditions requiring treatment in a Hyperbaric Oxygen Unit
  • Multiple severe injuries
  • Life-threatening trauma

Although these regulations seem quite clear,  you’ll see below that it is often easy for unscrupulous ambulance providers to skirt them. 

Our California Ambulance Fraud Lawyer Explains How This Fraud May Occur

Ambulance fraud occurs when an ambulance service provider submits a fraudulent claim for reimbursement to Medicare. There are several ways this can be achieved, such as: 

  • Billing for services that were not provided 
  • Billing for non-emergency transport
  • Billing for transport to a non-authorized location
  • Billing for transport to a facility that was not the closest one
  • Billing for air ambulance transport when ground ambulance transport would have been appropriate 
  • Falsifying records to inflate the number of miles driven
  • Participating in kickback schemes for referrals

These schemes can result in significant losses for the Medicare program, which amounts to direct theft from American taxpayers, and can lead to serious consequences for the perpetrators. For example, in 2020, the U.S. Department of Justice sentenced two ambulance service providers in Guam to prison for their roles in a $10.8 million Medicare ambulance fraud scheme. 

Combatting Ambulance Fraud Through the False Claims Act

Consumers, hospital personnel, dispatchers, EMTs, and insiders, such as employees and former employees of ambulance service providers, who have evidence of fraud being perpetrated against the Medicare program may be able to pursue a qui tam action under the False Claims Act. Learn more about how to combat healthcare fraud through the False Claims Act here. 

Contact a California Ambulance Fraud Attorney 

For more information about ambulance fraud and what you can do to stop it, please contact a California ambulance fraud lawyer at the Evans Law Firm by using our online form or calling us at 415-441-8669.

 

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