MedStar Ambulance Inc., a Massachusetts-based ambulance company, has agreed to pay a $12 million medicare fraud settlement to resolve claims that it fraudulently billed Medicare for its services.

The $12.7 million medicare fraud settlement includes a payment of about $3.5 million to Dale M., a former MedStar billing manager, who filed the lawsuit under the whistleblower provisions of the False Claims Act in 2013.

“We expect those who participate in the Medicare program to provide services, including ambulance services, based on the medical needs of patients rather than their desire to maximize profits,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer in a press release about the medicare fraud settlement.

Details of the allegations suggest MedStar routinely billed Medicare for transports that were not medically necessary and by up-coding the runs to exact higher payments from the government between 2011 and 2014.

Dale M. brought the case forward in Federal District Court in Massachusetts in 2013 after she said she was fired because of “her continued questions” about the alleged fraudulent billing and attempts to correct the documentation.

In one example, alleged Dale, a patient was transported by stretcher roundtrip by MedStar to see a urologist for a routine pre-scheduled medical appointment. For the transport, MedStar billed Medicare $1,130, despite the patient not being confined to bed and able to walk.

In another example of the alleged fraudulent billing practices, Dale said MedStar would be called by a municipal ambulance service that only provided basic life support services to “intercept” a patient that needed advance life support.

In those situations, according to Dale’s allegations, MedStar would bill Medicare for the full amount of the transport, when it was supposed to bill the municipality for an agreed-to contract amount usually between $250 and $275. The municipality was then responsible for billing Medicare, the whistleblower lawsuit alleged.

The whistleblower lawsuit sought damages for three counts, two related specifically to the “false claims” and one for retaliation by MedStar against Dale., who claims she was fired in 2013 because she continually questioned the alleged fraudulent billing and for her attempts to correct the documentation.

“This was a case in which the evidence obtained in the 3-year litigation was clear in that it showed that the MedStar companies fraudulently over-billed Medicare and added false information to the ambulance run documents to make them Medicare eligible when they otherwise would not have qualified for reimbursement,” said Dale’s attorney in a press release.

The alleged Medicare fraud took place at several Massachusetts MedStar locations, according to court documents.

As part of the medicare fraud settlement, MedStar must enter into a Corporate Integrity Agreement with the Office of the Investigator General, which requires employee training, the hiring of a compliance officer, and filing annual status reports to the federal government.

Whistleblower Lawsuits

In a whistleblower lawsuit, or qui tam lawsuit, an individual with knowledge of an organization’s activities provides information about fraud, corruption or other illegal activity. Whistleblowers are often employees, former employees and others who have access to company documents and internal information. Whistleblowers often receive a small percentage of the settlement.

Whether you have evidence of fraud against the government or corruption at a private company, an experienced whistleblower attorney can investigate your claim and advise you on your legal options.