The United States government has hit a Maine ambulance service with a lawsuit, alleging it has engaged in ambulance billing fraud.

According to the lawsuit, the ambulance service North East Mobile Health Services (NEMHS) submitted Medicare claims for patients whose emergency transport was not medically necessary.

Billing for the services of an ambulance should only go to Medicare if the ambulance was used for transportation during a real medical emergency. If another method of transportation could have been used without putting the patient’s health in danger, then Medicare should not be billed.

However, the lawsuit alleges that NEMHS actually billed Medicare for medically unnecessary services. The U.S. claims the company made a practice out of falsely claiming that patients were “bed-confined” when they were actually capable of walking to and from the ambulance and around their hospital rooms.

Records from NEMHS allegedly show many patients claiming that they were perfectly able to stand and walk. The lawsuit cites knee replacement surgery patients as those whose transportation was billed to Medicare, though in many cases these patients were soon able to walk, constituting ambulance billing fraud.

Indeed, the lawsuit claims, “NEMHS sought and received funds from Medicare for such false and fraudulent medically unnecessary ambulance transports in numerous instances where patients were not “bed-confined” and did not otherwise require ambulance transportation. NEMHS knew this.”

Furthermore, since at least 2012, the lawsuit alleges, NEMHS knowingly kept overpayments of Medicare funds that it was not actually entitled to and failed to report or return the funds.

The U.S. government filed its ambulance billing fraud lawsuit on Feb. 23, 2018, in the U.S. District Court for the District of Maine. The ambulance billing fraud was filed on multiple counts, including false or fraudulent claims, false records or statements, reverse false claims, and unjust enrichment.

Filing a Whistleblower Lawsuit

Whistleblowers are individuals who report illegal activities against the government including ambulance billing fraud by either their current or former employers. Many employees choose to come forward as whistleblowers because they do not feel right about their employer’s actions.

A whistleblower lawsuit can be filed by an employee while they are working at the company, but can also be filed after the employee has left. There are regulations in place to protect whistleblowers from potential retaliation for their actions. The whistleblower is also typically given a substantial reward—often between 15 and 30 percent of the money recovered in the subsequent whistleblower lawsuit.

If you believe you have witnessed Medicare or Medicaid fraud and abuse, such as ambulance billing fraud, or other government fraud by your current or former employer, you may be able to file a whistleblower lawsuit (also known as a qui tam lawsuit) against your employer on behalf of the government.

The Ambulance Billing Fraud Lawsuit is United States of America v. North East Mobile Health Services, Case No. 2:18-cv-0008-NT, in the U.S. District Court for the District of Maine.