Three New York City ambulance companies have paid a total of $2.85 million to resolve claims of Medicare fraud. Metropolitan Ambulance & First Aid Corp. (now known as SEZ Metro Corp.), Metro North Ambulance Corp. (now known as SEZ North Corp.) and Big Apple Ambulance Service Inc. (formerly known as United Ambulance) have been accused of using falsified records to appeal a Medicare program refund demand.
According to the United States Attorney’s Office for the Eastern District of New York, the companies used, or caused the use of, hundreds of letters attesting to the need for an ambulance that were forged or otherwise purported to come from some neutral, disinterested health care provider when they in fact did not. The companies had charged Medicare tens of millions of dollars for ambulance trips that did not meet the standard for medically necessary transportation.
Medicare audited the companies’ past billings and concluded that the companies had charged Medicare tens of millions of dollars for ambulance trips that did not meet the standard for medically necessary transportation. Medicare demanded a refund and afforded the companies an extensive informal and formal appeals process to prove that their billings were proper.
Instead of contesting the refund demand fairly, the companies resorted to fraud when they could not otherwise prove an ambulance was medically needed. The government contended that the companies used falsified records to appeal the refund demand.
The settlement is part of the government’s emphasis on combating health care fraud. The False Claims Act has been used to recover approximately $3 billion since January 2009 in cases involving fraud against federal health care programs.
Larry Kaplan, a former Chief Financial Officer for one of the companies, originally filed the suit under the False Claims Act. Kaplan’s share of the settlement will be $618,450.
Defendant: Metropolitan Ambulance & First Aid Corp.
Criminal Charges: Medicare Fraud
City and State: New York
Exact Date: Not specified
Sentence or Outcome: $2.85 million settlement
Dollar Amount: $2.85 million
Defendant Name: Metropolitan Ambulance & First Aid Corp.
Crime: Medicare Fraud
State: New York
Year: Not specified
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Key Facts
- State: Federal
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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