American Medical Response (AMR), a Connecticut ambulance company, recently entered into a civil settlement agreement with the federal and state governments and has paid $601,759 to resolve allegations it submitted improper claims to Medicare and Medicaid for ambulance services.
The federal and state governments alleged that AMR often billed Medicare and Medicaid for advanced life support (ALS) services when it was only providing basic life support (BLS) services.
ALS services include services performed by a paramedic that require a high level of medical monitoring at the scene of an emergency response and in the ambulance. BLS services are lower acuity services that can be performed by an emergency medical technician or relate to the transport of the patient in the ambulance to a hospital or other medical facility.
In several towns in Connecticut, local fire departments provide ALS emergency services when a 911 call is dispatched. AMR was also dispatched to the scene of these calls to provide ambulance transport only; however, both AMR and the local fire departments billed Medicaid for ALS services when AMR only provided BLS. As a result, Medicaid paid twice for the paramedic services, once to the local fire departments and a second time to AMR.
To resolve the government’s allegations, AMR paid $601,759, which covers claims submitted to Medicare and Medicaid from January 2014 through December 2019. AMR also entered into a consent agreement with the Connecticut Department of Public Health in which it agreed to cease and desist the prohibited conduct and to pay a $25,000 civil penalty to the State of Connecticut.