Hospitals, ambulance companies share fraud liability burden
Hospital liability and the emergence of "throughput"
A recent settlement out of Jacksonville underscores an emerging scenario in which hospitals and health systems can be further implicated in ambulance fraud investigations and prosecutions. The case involved nine hospitals and an ambulance company that collectively paid $7.5 million to settle claims that the providers submitted false claims to Medicare for non-emergency rides.
Although the Department of Justice statement described a straightforward case of upcoding and billing for unnecessary services, U.S. Attorney A. Lee Bentley told the Wall Street Journal that hospitals benefited by improving "throughput," or the speed at which they could admit and discharge patients in the emergency department. He went on to say that there was "no reason to believe this isn't going on elsewhere throughout the country." Unnamed sources added that the U.S. Attorney's Office for the Middle District of Florida has been in contact with three other U.S. Attorney's Offices that are broadening their own ambulance investigations.
McKenna said that allegations of increasing ED "throughput" alone are difficult to prove, as the process can be classified as an indirect benefit. Ultimately these cases still rely on evidence of unnecessary services.
"The underlying allegation is not only that it directly benefits you by doing this but, also, [the services] weren't necessary," he said.
However, the fact that other U.S. Attorney's Office may focus on this issue could trigger an expansion of potential liability as the feds seek to expose non-quantifiable factors, McKenna added. That could have meaning for providers outside of ambulance companies.
"There could be broad implications if it's true that is a trend and truly is being pursued by other U.S. Attorney's Offices around the country," he said. "It could be easily applied to other segments of the industry."
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