Up-Charge

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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.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”$12.7 Million Settlement in Whistleblower Medicare Fraud Case Against Mass. Agency,” published by EMSWorld on January 16, 2017.

BOSTON – January 13, 2017 – Jeffrey Newman Law, a law firm dedicated to representing whistleblowers nationwide has announced that MedStar Ambulance, Inc. and its related companies have agreed to pay $12.7 million to settle a False Claims Act lawsuit alleging the company fraudulently billed Medicare for unqualified ambulance services.

The whistleblower, former billing manager Dale Meehan, represented by Attorney Jeffrey Newman Esq. of Boston, alleged MedStar knowingly and fraudulently billed Medicare for ambulance services by billing for ambulance transports that were not medically necessary and by up-coding the runs to exact higher payments from the government.

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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.