Florida Ambulance Fraud Whistleblower Attorney
Ambulance fraud drains billions from government-funded programs and can lead to serious harm for patients who need genuine emergency medical services. From unnecessary transportation to kickbacks and billing for unrendered services, these types of healthcare fraud are a direct violation of the False Claims Act.
Federal law protects and rewards those who have the courage to step forward for what is right. At Yormak Employment & Disability Law, we know that blowing the whistle can keep diligent healthcare providers awake at night, especially when your job is on the line.
But you don’t have to face this alone. Our lead attorney, Benjamin Yormak, is a board-certified expert in employment law and has helped employees throughout Florida report government fraud. Contact Yormak Employment & Disability Law today for a free consultation.
The Role of Whistleblowers in Ambulance Fraud
In an ideal world, every ambulance ride would be a necessary one, and every bill should accurately reflect the services rendered. Unfortunately, many ambulance providers exploit the system for financial gain. This is where whistleblowers come in.
Blowing the whistle helps hold fraudulent healthcare providers accountable for their actions, ensuring that government funds are used appropriately and that patients receive the care they need without being exploited for financial gain.
Common Types of Ambulance Fraud in Florida
Ambulance fraud happens in various ways, notably billing for unneeded services and unlawful kickbacks. These actions impact the healthcare industry, patients, and the federal government. Below are common types of violations.
One of the most common types of ambulance fraud is unnecessary transportation. This happens when patients are transported by ambulance when it’s not medically necessary.
For instance, if a patient could have safely traveled by taxi or private vehicle, but an ambulance was used instead, this could be considered fraud. Hospitals might also discharge patients via ambulance transport when no ambulance is needed.
A kickback is an illegal payment made in return for a favor or service. In this case, ambulance companies might offer kickbacks (like cash or other benefits) to entities like hospitals or government-funded programs. In exchange, they expect to receive contracts for providing ambulance services at discounted rates. This practice is illegal under the Anti-Kickback Statute.
Billing for Services not Rendered
Billing for services not rendered involves an ambulance company billing for medical care that was never provided during transport.
For instance, if an ambulance company bills for advanced life support services when only basic life support services were provided, this would be considered fraud.
Fabricating patient care reports to justify medically unnecessary transport or higher levels of service is a common healthcare fraud.
This activity involves manipulating patient records to present a false narrative. Ambulance companies might exaggerate the patient’s condition, symptoms, or even create whole scenarios that never occurred.
This is a common type of ambulance fraud. It occurs when an ambulance company intentionally bills the patient’s private insurance and the government-funded Medicare program for the same service, receiving double payment for a single service.
While billing for unrendered services relates to patient care during transportation, ghost rides bill insurance companies or government-funded programs for patients who were never transported, creating fake records.
Inflated Mileage Claims
Ambulance companies intentionally overstate the distance traveled during patient transport. This increases the billing amount, as ambulance services are often charged based on the miles covered.
Ambulance companies have created shell companies to lease ambulances to themselves, defrauding insurers by inflating operational costs.
This practice is a sophisticated form of deception that involves complex transactions designed to conceal the true nature of the fraud. The ambulance company, through the shell company, leases ambulances at prices far above market rates.
Air Transportation Fraud in Healthcare
Unnecessary air travel is a type of fraud that can cost government-funded programs thousands of dollars per trip.
As is the case with regular ambulances, unnecessary air transportation involves using expensive air ambulance services when they’re not needed.
Given the elevated costs for air transport, the Center for Medicare and Medicaid Services (CMS), a federal agency overseeing healthcare programs, has strict guidelines for cases where air transportation should be an option based on the following criteria:
- A patient’s medical condition requires immediate ambulance transportation that cannot be provided by ground ambulance.
- Great distances or other obstacles are involved in getting the patient to the nearest hospital with the right equipment.
- When other means of transportation pose a threat to the patient’s survival or seriously endanger their health.
Furthermore, CMS’s guidelines even include a list suggesting possible instances in which air travel would be reasonable:
- Intracranial bleeding
- Requiring neurosurgical intervention
- Severe cardiac issues
- Burns requiring treatment in a burn center
- Need for a Hyperbaric Oxygen Unit
- Many severe injuries
- Life-threatening trauma
Similar to ground transportation, there are plenty of opportunities for violations related to mileage and distances covered by air transport. Here are two common types of fraud in air transport:
Mileage Rate Calculation: The air ambulance mileage rate is calculated based on the distance flown with a patient onboard. Fabricated bills often submit longer distances to increase reimbursement from government-funded programs.
Focus on Loaded Miles: Air transport costs are based on the distance covered while a patient is on board the aircraft. This implies that the costs or payments for any travel without a patient should not be included in this mileage rate. When these are included, reimbursements are inflated.
The False Claims Act
The False Claims Act (FCA) is a federal law that makes it illegal to defraud government programs. Under the FCA, individuals who knowingly submit false claims to the government can be held liable.
The False Claims Act protects whistleblowers from retaliation and provides financial rewards for those who help the government recover funds lost to fraud.
If your whistleblower claim leads to a successful lawsuit or settlement, you could receive between 15% and 30% of the recovered funds. This can amount to a substantial sum, especially in cases involving large-scale healthcare fraud.
Contact Us for a Free Consultation
If you’re considering blowing the whistle on ambulance fraud in Florida, it’s crucial to have an experienced attorney by your side. The process can be complex and intimidating, but you don’t have to navigate it alone.
At Yormak Employment & Disability Law, we understand the intricacies of whistleblower claims under the False Claims Act. Our lead attorney, Benjamin Yormak, is a board-certified expert in employment law with a proven track record of success in whistleblower cases. Contact Yormak Employment & Disability Law today for a free consultation.