Taken for a Ride

9

Who knew that ambulance misuse was such a big driver of health care fraud? Apparently, the federal government did. A report by the Philadelphia Business Journal points to ten Philadelphia-area ambulance companies that were recently indicted for filing fraudulent Medicare claims to the tune of $20 million, over the past five years. (That’s a reason to sound the sirens!)’

Keep in mind that Medicare (along with probably every private provider in existence) does not cover ambulance transportation costs unless other transportation could endanger a patient’s health. The Journal report centers on one particular ambulance company, whose owner, employees and even patients collaborated on a scheme that defrauded Medicare using a number of different deceptions. (No points for creativity in cheating.)

The company submitted to Medicare reports that falsified some patients’ need to be transported by ambulance. The scam also involved offering patients incentives to develop ailments that ”required” ambulance rides. (How did that work—here’s twenty bucks to pretend you’re unconscious?) Additionally, the company submitted claims for ambulance rides, when, actually, the patients had been driven in personal vehicles.

But remember: this company was only one of many conducting similar schemes (sigh), so it was only a matter of time before the federal government took notice. And, boy, did they. A joint investigation by the Department of Health and Human Services, the Federal Bureau of Investigation and the Department of Labor ended with an array of indictments, prison sentences and orders for restitution. Ultimately, the owner of the company detailed above pleaded guilty to health care fraud and violating the Anti-Kickback Act, for which she was sentenced to 64 months in prison and ordered to pay back $2 million to Medicare. Similarly, a medical technician she employed received a 37-month prison sentence, was ordered to pay $2 million in restitution to Medicare, another $14,150 to Pennsylvania and a $300 special assessment. There was no ‘brotherly love’ to be found in this story.

Source: Today’s ”Fraud of the Day” is based on ”Ambulance fraud probe yields 37-month prison sentence for EMT,” written by John George and published by Philadelphia Business Journal on March 10, 2016.

A 39-year-old emergency medical technician was sentenced to 37 months in prison for his role in an health care fraud scheme perpetrated by a Philadelphia ambulance company.

Fritzroy Brown, of Philadelphia, was employed by Brotherly Love Ambulance Inc., where he transported patients who were able to walk and could travel safely by means other than ambulance — making them ineligible for ambulance transportation under Medicare requirements.

Brown and other conspirators at Brotherly Love Ambulance also falsified reports to make it appear that the patients needed to be transported by ambulance. In addition, Brown and other conspirators paid kickbacks to patients to ensure that they would use Brotherly Love Ambulance for services which were not medically necessary. Brown and others at the ambulance company also submitted documentation for transports that made it appear that the individuals had been transported in an ambulance when they had actually been driven in personal vehicles.

The founder and president of Brotherly Love Ambulance, Feda Kuran, 39, of Philadelphia,, was sentenced in 2014 to 64 months in prison after pleading guilty to health care fraud and paying kickbacks in violation of the federal Anti-Kickback Act.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.