National ambulance company Rural Metro “created and/or submitted documentation that falsely represented that a patient was either bed-confined or that transportation by ambulance was otherwise medically required” said DoJ in a prepared statement shortly after filing a Complaint in partial intervention on behalf of the United States late last week.  Rural/Metro Corporation is a provider of medical transportation services in approximately 400 communities throughout the United States with reported net revenue of over $530,000,000 last year, 42% of which was paid by Medicare and 19% of which was paid by Medicaid.

The suit, originally filed by Frohsin & Barger on behalf of former Rural Metro employee Carl Crawley, alleges that Rural Metro engaged in a company-wide effort to inflate its Medicare and Medicaid billings by providing ambulance services to routine dialysis patients where they knew significantly less costly standard medical transport was indicated. DoJ validated Crawley’s concerns, stating that “many of those patients were neither bed-confined nor needed to be moved on stretchers, and did not require ambulance transportation or qualify for ambulance transport under the applicable Medicare or Medicaid requirements.” While the allegations do not relate to quality of care issues, the alleged practices harm taxpayers and the entire healthcare system by siphoning funds that could otherwise be used to address legitimate healthcare concerns.

“The defendants’ submission of false claims to Medicare and Medicaid resulted in unnecessary expenditures from these programs” said United States Attorney Joyce White Vance. “The United States intends to aggressively pursue the recovery of the Medicare and Medicaid funds improperly obtained by the defendants in this case.” Vance’s team is led by Assistant United States Attorney Lloyd Peeples, who together with Frohsin & Barger is responsible for the largest qui tam recovery in Alabama history and the largest Medicare Hospice recovery in the country.  

“Our client Mr. Crawley recognized this problem which harms all Americans, and he was brave enough to come forward to try to stop it,” said Jim Barger, one of the attorneys who filed the case. “Unless people like Mr. Crawley take a stand against this type of thing, our country’s healthcare system will continue to bleed hundreds of billions of dollars and eventually will expire.”

As a qui tam relator under the False Claims Act, Mr. Crawley may receive as much as 25% or more of the recovery, which can be up to three times the damages plus penalties, interest, attorneys’ fees, and costs.  Read the Government’s Complaint in its entirety below:

Complaint in Intervention
[scribd id=52293899 key=key-udscy3d09vyl95sgk4u mode=list]
FraudBlawg has previously reported on Crawley ex. rel U.S. v. Rural Metro here and here.

To report ambulance fraud or other Medicare fraud, contact Frohsin & Barger.