This article addresses how to receive a reward for reporting Ambulance fraud.

Medicare and Medicaid pay ambulance companies for their cost of transporting Medicare or Medicaid patients. But, it is Medicare fraud or Medicaid fraud when an ambulance company bills Medicare or Medicaid for routine and non-emergency ambulance transportation. Examples of ambulance fraud include transporting an elderly person to routine doctor visits or follow up exams at the hospital or other healthcare provider.

Examples of ambulance fraud: non-emergency transportation fraud or free rides

Some ambulance companies offer “free” rides in ambulances to take Medicare or Medicaid recipients to medical appointments that are not emergencies. Although we can’t blame an elderly person who accepts the transportation to their doctor or routine medical appointments, it is Medicare fraud for the ambulance company to bill Medicare for the ambulance ride.

To be eligible to be reimbursed by Medicare or Medicaid, the ambulance company must certify to Medicare or Medicaid that the ambulance transportation was an emergency transport. If the ambulance company lies or cheats Medicare by billing for routine transportation to doctor visits or hospitals for follow up examinations, the ambulance company violates the False Claims Act and is liable to repay triple the amount of the ambulance fraud.

Examples of ambulance fraud: billing for advanced life support services (ALS fraud)

It is Medicare fraud to bill for advanced life support services (ALS) when basic life support services (BLS) are provided. Documentation is falsified to state that the patient needed oxygen when it was not necessary. One key indicator to establish medical necessity for advanced life support services (ALS) is that the patient needed oxygen. Thus, it is one of the more common ambulance fraud schemes to lie about the patient needing oxygen.

Examples of ambulance fraud: billing for extra or additional miles

Another example of ambulance fraud is billing for more miles than actually traveled for the medical or ambulance transport. Even air ambulance services have been known to lie about the mileage and have billed for  mileage using ground miles, such as using google maps or map-quest, instead of nautical miles.

How to receive a reward for reporting ambulance fraud

Many ask how to report ambulance fraud and receive a reward. The government pays whistleblowers a reward for reporting ambulance fraud. But you must report ambulance fraud in a particular way to receive a whistleblower reward. You will not receive a reward by calling a hotline or even sending an email to the government to report ambulance fraud. Instead, you must hire an attorney (on a contingency basis) to file a False Claims Act qui tam action against the ambulance company that is cheating Medicare. You will need specific evidence of ambulance fraud to support the suit and convince the government that ambulance fraud took place. Next, the government must not only prove the ambulance fraud, but require the ambulance company to repay Medicare for the amount of the ambulance fraud.

How to determine the amount of a whistleblower reward for reporting ambulance fraud

The amount of the whistleblower reward for reporting ambulance fraud is a percentage of the amount of money the ambulance company repays for defrauding Medicare or Medicaid. For instance, if an ambulance company charges Medicare $3 million in ambulance transportation over 6 years for routine or non-emergency transportation, the ambulance company it is liable to repay Medicare $9 million. That is the amount that one ambulance company paid to settle allegations of ambulance fraud against Medicare. In that case, the whistleblower received a reward of $1.6 million for reporting the ambulance fraud. Under the whistleblower reward statute, a whistleblower receives a reward of between 15-25% of the amount the government recovers. Other ambulance companies have repaid $20 million for ambulance fraud, with the whistleblower receiving $3.8 million as a reward. (Sometimes even taxi companies have billed Medicare, pretending to be an ambulance.)

How to decide whether to report ambulance fraud

Mr. Hesch is available to evaluate your allegations of ambulance fraud. You can find out in confidence whether Mr. Hesch thinks you have the type of ambulance fraud case where you may be eligible for a significant monetary reward. How to report ambulance fraud and seek a whistleblower reward begins by filling out the questionnaire on this website. Mr. Hesch and the team of attorneys that work with him on Medicare ambulance fraud cases will review your information and let you know if they can represent you in reporting ambulance fraud.

See the link below “Do I have a case” to have Mr. Hesch review your potential whistleblower reward case for ambulance fraud.

See the link below “Report Fraud” to learn more about the government’s whistleblower reward program relating to ambulance fraud.