On May 8, the U.S. Attorney's Office for the Middle District of Florida announced that nine Florida hospitals have agreed to pay $6.2 million to settle allegations that they led ambulance companies to bill for medically unnecessary rides. The settlement resolved allegations that between 2009 and 2014 the hospitals provided Certificates of Medical Necessity showing the need for ambulance transportation even when ambulance services were not medically necessary.
This settlement has been discussed widely in government circles and caught the attention of many in the industry because of its implications for hospitals across the country which often rely on ambulances to transport patients to and from their facilities, at times with insufficient attention to the cost or medical need. In fact, according to a report by the Wall Street Journal, the U.S. Attorney’s office for the Middle District of Florida has been in contact with three other U.S. attorney’s offices, prompting those offices to broaden separate ambulance investigations they have underway.
So, what does all of this mean? A few takeaways:
- In an era of court decisions increasingly limiting False Claims Act liability to explicit conditions of payments, DOJ and the Office of the Inspector General (OIG) will continue to focus on documentation that is a condition of payment, like Certificates of Medical Necessity. Providers would be well served to carefully examine their processes for signing these and ensuring that this type documentation is accurate and correct, especially in situations where they may be depending on information from a third party (like an ambulance company).
- The DOJ and OIG will continue to target hospitals and other facility-based providers, even in situations, like here, where the problematic conduct occurred outside of the hospital itself. This focus comes from the amount of reimbursement that flows to these providers as well as the fact that the DOJ and OIG tend to view them as relatively deep pockets.
- This case was brought by a relator. Other relators’ counsel, including those well versed with hospital and ambulance operations, will take notice. Hospitals should heed the warning of the government and carefully examine their relationships with ambulance companies and any Certificates of Medical Necessity that may be provided for rides. If questions about the propriety of any of those activities arise, providers should consider investigating the conduct through counsel, and if necessary, disclosing any overpayments.