Ambulance Owner going to Prison dialysis run fraud

medic417

medic417

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More in-depth than the original posting newsbrief.

http://7thspace.com/headlines/36030...er_sentenced_in_health_care_fraud_scheme.html

"As part of the conspiracy, the defendants told Royal and First Choice employees to omit facts when documenting their transports of Royal and First Choice patients, such as whether the patients walked to the ambulance, in order to qualify the transports for reimbursement. Additionally, many of the companies’ records revealed that patients simply rode to their appointments in a captain’s chair in the back of the ambulance rather than lying on a stretcher."
 
And people get pissed off at us when we ask them to fill out the PCS completely and accurately.

On topic, how did they get PCS forms justifying the recurring transports?
 
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I think more people need to go to jail for falsifying medical necessity for many IFTs.

This is not the only company that does this. I wager not even the tip of the iceberg.

Along with agencies that encourage medics to do "the maximum" for patients "just incase" in order to bill ALS.

Infact I think they should go after individual providers as well.
 
Veneficus said:
I think more people need to go to jail for falsifying medical necessity for many IFTs.

This is not the only company that does this. I wager not even the tip of the iceberg.

Along with agencies that encourage medics to do "the maximum" for patients "just incase" in order to bill ALS.

Infact I think they should go after individual providers as well.
Click to expand...


I agree. I think there needs to be better training and education all around. It has never made sense to me that every year I have to pass a PCS class and nurses/doctors don't, when they are the ones filling them out.

I'm not so sure about going after individual providers unless they have extensive proof. I would worry that new providers would end up targeted, and lazy providers would end up rewarded. I know there are times when I've done things just to find something out that could be considered excessive. For example, running a quick 3 lead to find out if someone's pacemaker is firing or not. Or else, there should be a way to be able to do that, without charging for EKG monitoring, since I wasn't monitoring, I was assessing. Or is that too hairsplitting?
 
How about to encourage reporting of fraud have an anonymous reporting system where you are assigned a report number. Then when company is found to have committed fraud you as the Paramedic or emt present that number and because you did your job by reporting face no charges but if they ask and you did not report the fraud you face charges. This allows you to keep a paycheck while also helping to cut down on fraud. Companies would be afraid to commit fraud knowing the employees would report in order to protect themselves. I would not offer a cash reward because would lead to people trying to do things to get companies in trouble.
 
I like that idea, the only thing I would change would be that anyone could file a report, family, nurses, facilities etc. Employees of any health care service could receive the report number. That way the pool of reporters is larger, offering more anonymity and increases the chance of fraud being reported.
 
How do you recommended lowly road personnel educate themselves on the details of medicare reimbursement and Medical Necessity laws?
 
emt.dan said:
How do you recommended lowly road personnel educate themselves on the details of medicare reimbursement and Medical Necessity laws?
Click to expand...

Basic key items should be part of your education. But if patients walk unassisted to the cot and/or ambulance, need no O2, etc yet paperwork says they require assistance, they are bed ridden etc it is obviously fraud.
 
emt.dan said:
How do you recommended lowly road personnel educate themselves on the details of medicare reimbursement and Medical Necessity laws?
Click to expand...

No real need... just fill out your PCR correctly, with only what is true.


I had a patient with cellulitis on his leg a couple of months ago at a doctors office, and we (a Paramedic ambulance) were called out to take him to the hospital, less than a mile away. We walked in, he hopped up, walked over to my cot and sat down. I put "No medical necessity" on my PCR for where it ask reason for ambulance / stretcher. I got called in to the billing office some time later, and was told that they don't want that as it makes it hard for them to bill and to find something else to put.


My response? I said like hell I would. It's my license and my name on the report, and I would LOVE to see them make something out of it and walked on out.


You know what came of it? Nothing.... and I wonder why.
 
medic417 said:
Basic key items should be part of your education. But if patients walk unassisted to the cot and/or ambulance, need no O2, etc yet paperwork says they require assistance, they are bed ridden etc it is obviously fraud.
Click to expand...

I tend to look at it this way, how does the patient normally travel?

"Needs oxygen" doesn't fly if the pt is on O2 24/7 and routinely drives themselves around or takes a taxi with a portable O2 tank. An amputated leg wont qualify someone if they normally use crutches and get around without a problem. Even someone being in a wheel chair doesn't automatically qualify them since people in wheelchairs can travel other ways than by ambulance.

Linuss said:
No real need... just fill out your PCR correctly, with only what is true.


I had a patient with cellulitis on his leg a couple of months ago at a doctors office, and we (a Paramedic ambulance) were called out to take him to the hospital, less than a mile away. We walked in, he hopped up, walked over to my cot and sat down. I put "No medical necessity" on my PCR for where it ask reason for ambulance / stretcher. I got called in to the billing office some time later, and was told that they don't want that as it makes it hard for them to bill and to find something else to put.


My response? I said like hell I would. It's my license and my name on the report, and I would LOVE to see them make something out of it and walked on out.


You know what came of it? Nothing.... and I wonder why.
Click to expand...

You're lucky, we aren't allowed to fill out anything but the patient demographic information. My life would be much easier if I could fill out the whole thing myself.
 
medic417 said:
How about to encourage reporting of fraud have an anonymous reporting system where you are assigned a report number. Then when company is found to have committed fraud you as the Paramedic or emt present that number and because you did your job by reporting face no charges but if they ask and you did not report the fraud you face charges. This allows you to keep a paycheck while also helping to cut down on fraud. Companies would be afraid to commit fraud knowing the employees would report in order to protect themselves. I would not offer a cash reward because would lead to people trying to do things to get companies in trouble.
Click to expand...

Actually, you are protected by federal whistle blower status and while you may not want to return to work, as a plantif in a Qui tam lawsuit, you stand to win big.

There is even precident that the awards for thewhistle blower are greater than the fines the government levies.
 
Linuss said:
No real need... just fill out your PCR correctly, with only what is true.


I had a patient with cellulitis on his leg a couple of months ago at a doctors office, and we (a Paramedic ambulance) were called out to take him to the hospital, less than a mile away. We walked in, he hopped up, walked over to my cot and sat down. I put "No medical necessity" on my PCR for where it ask reason for ambulance / stretcher. I got called in to the billing office some time later, and was told that they don't want that as it makes it hard for them to bill and to find something else to put.


My response? I said like hell I would. It's my license and my name on the report, and I would LOVE to see them make something out of it and walked on out.


You know what came of it? Nothing.... and I wonder why.
Click to expand...

No nothing will come of this they will just put a target on you and wait until you do something questionable then hang you out to dry.

I don't have much experience with medical neccesatiy forms but aren't they supposed to be filled out by an rn.

I would think if the rn filled it out and signed it it would be her responsibility, not the ambulance provider.
 
PCS form can be filled out by a doc, RN, social worker, and a couple of others. But on the PCR we have our own. It has "Reason for ambulance / stretcher", "Reason for transport" and then our narrative.


PCR is all up to us. Typically if you get a PCS (which we only do for medicare patients) then yes, we can, as long as our assessment backs it up, use the reason on the PCS. But every other call, for people not on Medicare, we have to write the necessity based on our assessment.



Yay for a company still using paper PCRs....
 
An RN, Discharge Planner, Nurse Practitioner, PA, or MD can sign them depending on the situation.

That is part of the problem. They fill them out, but it falls on us to make sure that they are filled out correctly before submitting it. Not to pick on facility staff, but a lot of times they just want the patient out of their hair, and so they just jot something on the form like "bed ridden" or "dementia" and think that is enough.
 
medic417 said:
I miss paper.
Click to expand...

Wanna trade?


They bought GPS units for the trucks so dispatchers could know where we are at and "be more efficient". What ended up happening? Dispatch STILL asks us where we are.


If you want efficient, buy stuff that helps the street crews, don't make **** up claiming "efficiency".
 
How many of you work for a service that has a list of phrases not to use?
 
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