April 16, 2013 — Williston Rescue Squad Inc. in South Carolina has settled a False Claims Act lawsuit alleging that the company submitted false bills to Medicare. The lawsuit was filed by Sandra McKee, a clinical social worker at a health care facility to which Williston often transported elderly patients. Insider employees with health care providers are frequently the ones who come forward to put a stop to Medicare fraud. In this case, McKee filed a whistleblower suit under the False Claims Act’s qui tam provisions. These provisions allow private individuals to file claims for the government’s benefit and then share in the proceeds of any settlement. From the government’s settlement of $800,000, the whistleblower will retain $160,000.
Williston provides ambulance transportation in the southwest region of South Carolina. Those transportation services frequently involve ambulance rides for elderly Medicare beneficiaries. Medicare will pay for non-emergency ambulance transportation only when the patient is confined to a bed or is suffering from a medical condition that necessitates ambulance transportation. According to the Justice Department, Williston submitted claims for payment to Medicare for routine transportation that was not medically necessary. Then the ambulance company allegedly falsified documents so it would appear that the non-emergency transport satisfied Medicare requirements.
When Medicare fraud occurs, it is often insider employees who blow the whistle. They may work for the company actually engaged in the fraud or, as in this case, they may observe the misconduct while employed for a different health care service. Conscientious tipsters deserve to understand their rights before they notify the government. The whistleblower lawyers at Waters & Kraus offer government collaborators the experienced help they need. Contact us or call our qui tam attorneys at 800.226.9880 to learn more about our health care fraud practice and how we can protect you.