Jacksonville, FL – In a shocking case of medical malfeasance, nine hospitals in Jacksonville, Florida, have settled allegations that they routinely ordered basic life support ambulances for non-emergency transports, raking in millions in taxpayer dollars.
The United States Attorney’s Office, led by A. Lee Bentley, III, announced a $7.5 million settlement with Baptist Health, which owns and operates four hospitals in Jacksonville, Memorial Hospital, Specialty Hospital, Lake City Medical Center, and Orange Park Medical Center, UF Health Jacksonville, and Century Ambulance Service.
The investigation, which spanned multiple years, found that the hospitals provided Certificates of Medical Necessity attesting to the need for basic life support, non-emergency ambulance transports even when these transports were not medically necessary. Century Ambulance Service knowingly up-coded claims from Basic to Advanced life support, unnecessarily transported patients, and unnecessarily transported patients to their homes in an ’emergent’ fashion.
According to the US Attorney, the settlements resolved allegations that the hospitals and Century Ambulance Service submitted millions of dollars in false claims to Medicare, TRICARE, Medicaid, and the Federal Employees Health Benefits Program. The case was initiated by a qui tam lawsuit filed by Shawn Pelletier, a former employee of Century Ambulance Service, who will collect over $1.2 million in proceeds from the settlements.
US Attorney Bentley stated, ‘The United States Attorney’s Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud… Whether the fraud is intentional or the product of deliberate ignorance, we will pursue these cases and recover taxpayer money.’
Gregory E. Demske, Chief Counsel to the Inspector General of the US Department of Health and Human Services Office of Inspector General, said, ‘Hospital staff that certify the medical need for services when they are in fact not medically necessary fail in their role as gatekeepers of valuable taxpayer-funded health care programs… Billing Medicare and Medicaid for transports that amount to taxpayer-funded taxi services will not be tolerated.’
The United States was unable to reach a settlement with Liberty Ambulance and intends to pursue claims against the defendant, alleging that Liberty knowingly submitted medically unnecessary claims for reimbursement in violation of federal healthcare program requirements.
The case is a stark reminder of the importance of holding healthcare providers accountable for their actions and the need for vigilance in protecting taxpayer-funded healthcare programs.
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Key Facts
- State: Florida
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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