Texas Ambulance Company Supervisor Pleads Guilty in Health Care Fraud Case

[MMiz]

Texas Ambulance Company Supervisor Pleads Guilty in Health Care Fraud Case

A former high-level employee of Royal and First Choice ambulance services, Shaun Outen, 32, of Aubrey, Texas, pleaded guilty yesterday in federal court to one count of conspiracy to commit health care fraud, announced U.S. Attorney James T. Jacks of the Northern District of Texas. Outen faces s a maximum statutory sentence of five years in prison, a $250,000 fine and restitution. Sentencing is set for June 16, 2010, before U.S. District Judge Jorge A. Solis.

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[mycrofft]

I'm familiar with this wrinkle.

It is common to deny assistance of varying sorts to pt's who do anything outside the home..or sometimes out of a chair or bed, period.
When healthcare is nationalized, then all fraud against it will be federal, not local.

 

[triemal04]

Unfortunately, part of what they did is very, very common. When medicare looks at whether or not a call should get reimbursed, if the chart includes the words, "ambulates," "walks" or some variations of those as it pertains to how the pt moved to the gurney/ambulance, then reimbursement will almost always be refused. Unfortunately, much of the decision making process for that is done electronically by a computer; nobody with medical training is required to look over the charts. Of course, it is still possible to challenge Medicare's decision, but that requires more time and effort.

Hence why some places demand that their employees do not use certain words in their charts, or, at the illegal end, chart something that didn't happen.