A Pennsylvania fire company cited by the US Department of Health & Human Services for improper EMS billing of Medicare/Medicaid, has reached a settlement with the US Department of Justice. At the heart of the case is the fact that certain personnel assigned to the EMS units lacked the proper credentials, which when coupled with billing Medicare/Medicaid patients triggered a possible federal False Claims Act violation.
The Manoa Fire Company of Haverford Township agreed to pay $36,912.46 to resolve the dispute, thereby avoiding the need for litigation. The company was accused of billing for EMS transports with crew members who failed to meet the minimum EMS requirements under state law. The incidents allegedly occurred between July 23, 2007 and September 30, 2013.
According to the settlement agreement provided by the DOJ, EMS billing to Medicare/Medicaid for transportation:
- must meet four principal criteria: (1) they must be medically necessary; (2) they must be provided by an ambulance company that is licensed in accordance with federal regulations and the regulations of the state in which the services are provided; (3) they must be provided in an ambulance that is properly equipped and functions in accordance with federal regulations and the regulations of the state in which the services are provided; and (4) they must be rendered by personnel who are properly licensed and trained in accordance with federal regulations and the regulations of the state in which the services are provided. …
- Specifically, pursuant to 28 Pa. Code§ 1005.IO(d)(l)(i), the Commonwealth of Pennsylvania mandates that each ambulance rendering Basic Life Support (BLS) services be staffed with at least two people. One of these individuals must be a licensed Emergency Medical Technician (EMT). The other, who is called an “Ambulance Attendant,” must be actively certified in advanced first aid and have a CPR certification that is less than two years old.
- On the occasions in question between July 23, 2007 and September 30, 2013, due to an absence of administrative oversight, MFC billed for services rendered by at least four ambulance attendants whose advanced first aid certifications had lapsed or who had not timely received such certifications in the first instance.
The HHS and the DOJ initially took the position that the fire company violated the False Claims Act . However, according to the settlement, the Manoa Fire Company did the right thing once the problem was identified:
- When it was notified of the United States’ investigation, MFC immediately retained outside counsel and an auditor. MFC undertook efforts to determine whether the allegations were justified, and it cooperated fully in the United States’ investigation. When MFC ultimately determined that the foregoing … might have occurred, it accepted responsibility for its actions and those of its volunteers.
- In order to ensure that the problems do not recur, MFC took several remedial measures. First, it immediately stopped any volunteer whose certifications were not current from serving as the Ambulance Attendant on its BLS runs. Second, it arranged training for those individuals to ensure that its volunteer staff was trained and certified in accordance with Pennsylvania law. Finally, it purchased a software system and arranged for its volunteers’ certification and training records to be placed into the system.
Here is a copy of the settlement: Manoa Settlement Agreement