There are many types of salesmen known for luring customers in with an offer that can’t be refused. Before you know it, you have agreed to buy a product with more features than you need and you’ve paid an up-charge that has busted your budget. An ambulance company slapped the government with some fraudulent up-charges, but an internal employee slapped back by blowing the whistle on her employer for the illegal practice.
The former billing manager for the company alleged that the ambulance company billed Medicare for transports that were not medically necessary. On top of that, the unqualified claims were up-coded in order to receive more money back from the federal health care program. (False information was added to the ambulance run documents to make them appear to be Medicare eligible.)
The whistleblower tried to correct the fraudulent billing, but was terminated from her job after she continued to question the company’s practice of up-charging. After a three-year litigation process, the ambulance company and their related companies agreed to pay $12.7 million to settle the False Claims Act lawsuit. (The whistleblower will receive $3,556,000 for her efforts to stop the illegal practice.)
In addition, the ambulance company also must enter into a Corporate Integrity Agreement with the Office of the Inspector General (OIG). This means the company has to implement employee training, hire a compliance officer and provide annual status reports for the OIG to comply.
Congratulations to the whistleblower who had the courage to take on her deceptive employer and its up-charge scheme. The government has no tolerance for companies that try to make extra money off of a government benefits program. In the end, the ambulance was stopped from driving away with undeserved profits and the whistleblower profited from telling the truth."Up-Charge",