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Ambulance Company Settles Whistleblower Lawsuit Over Alleged Medicare Fraud

A medical transportation company that provides ambulance service in several states has settled a False Claims Act lawsuit for $5,426,000, according to a recent announcement by the U.S. Attorney’s Office in Birmingham, Alabama.

The lawsuit, which was brought by a former employee of the company under the qui tam provisions of the False Claims Act, alleged that Rural/Metro Corporation, Rural/Metro of Central Alabama Inc., and Mercury Ambulance Service, doing business as Rural/Metro Ambulance, submitted Medicare reimbursement claims for ambulance services that were either medically unnecessary or never provided.

The whistleblower will receive over $1 million for his role in bringing the company’s alleged false claims to light. The lawsuit was filed in federal court in Alabama in 2009. The U.S. government intervened in the lawsuit in March 2011.

According to the allegations, Rural/Metro Ambulance sought fraudulent Medicare reimbursements in Tennessee and Alabama between 2008 and 2011 for non-emergency transportation services provided to Medicare patients receiving dialysis. Mercury Ambulance similarly fraudulently charged Medicare for non-emergency transport for Medicare patients receiving dialysis in Kentucky, according to the lawsuit.

Medicare pays ambulance services claims only in cases where the patient’s medical condition requires it. Typically, this means that for ambulance services to be reimbursed, the patient must be bedridden or otherwise suffer a medical condition requiring ambulance transportation. Many of the patients transported by Rural/Metro ambulances, however, were neither bed-confined nor required to be moved on stretchers. Because the patients’ condition did not warrant ambulance transportation, the company was not entitled to reimbursement under Medicare’s provisions.

The False Claims Act allows individual whistleblowers to file suit on behalf of the U.S. government when they believe that the defendants have committed fraud on the government by submitting false claims for government funds. For pursuing the lawsuit and bringing the wrongdoing to light, whistleblowers are entitled by law to receive a share of any judgment or settlement received by the government. The law also allows the government to recover three times its damages in addition to civil penalties.

The U.S. government has placed particular emphasis on fighting Medicare and Medicaid fraud in recent years. announced by the Attorney General and the Department of Health and Human Services in 2009, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) is an essential tool in this crackdown.

Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

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