'; if(pArray.length >= 4) { i=2; } else if(pArray.length >= 3) { i=2; inline = ''; } else if(pArray.length >= 2) { i=1; inline = ''; } else if(pArray.length === 1) { i=0; inline = ''; } $('#librarydrawer_story_container script').each(function() { $(this).remove(); }); $(pArray[pArray.length - 1]).after(subscribeBox); $(pArray[i]).after(inline).after($('#librarydrawer_story_container')); $('#text-story').focus(function() { if ($(this).val() == 'EMAIL ADDRESS') { $(this).css({color: '#000000', backgroundColor: '#ffffff'}); $(this).val(''); } }); $('#text-story').blur(function() { var trim = $(this).val().replace(/[\s]/g, ''); if(trim === '') { $(this).val('EMAIL ADDRESS'); $(this).css({color: '#666666', backgroundColor: '#f8f8f8', border: '#666666 1px solid'}); } }); $('.content-subscribe .btn-submit').click(function() { var val = $('.content-subscribe .text').val(); if(val.search(/[a-z0-9!#$%&'*+\/=?^_`{|}~-]+(?:\.[a-z0-9!#$%&'*+\/=?^_`{|}~-]+)*@(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?/gi) === -1) { $('.content-subscribe .text').css('border', '#ff6600 1px solid'); $('.content-subscribe .text').focus(); return false; } return true; }); }); //-->

Hospitals, ambulance companies share fraud liability burden

As federal prosecutors focus on non-emergency transportation services, hospitals could be targeted for increased "throughput"

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."

Related Articles:
Coast-to-coast settlements hone in on ambulance transport fraud
Fraud crackdown drives 11 N.J. ambulance operators out of business
Ambulance fraud masterminds brought to justice
Ambulance services contribute to $350M in fraud annually
CMS launches ambulance precertification program
CMS stops taking new provider applications in fraud zones