A Maine hospital and its preferred ambulance service have agreed to a $1.4 million Medicare fraud settlement, despite neither admitting to wrongdoing.

Maine Medical Center in Portland, Maine agreed to pay $600,000 rather than face a trial regarding allegations that hospital employees provided the ambulance service with incomplete or falsified paperwork to make it appear patients needed a ride in an ambulance. The ambulance service, North East Mobile Health Services, used that same paperwork to bill Medicare.

North East Mobile Health Services operates out of Scarborough and has agreed to pay $825,000 of the Medicare fraud settlement.

Medicare only covers the cost of an ambulance if the patient physically is incapable of walking or of sitting in a wheelchair. If a patient is at all mobile, a car or wheelchair van could be used to transport the patient. Medicare does not pay for car or wheelchair van transportation options.

Lawyers for the government allege that by falsifying the patients’ needs and providing medically unnecessary services, the hospital and ambulance service violated the federal False Claims Act (FCA).

North East has been Maine Medical Center’s preferred provider for ambulance transport services since 2007. North East’s alleged Medicare fraud occurred from October 2007 to December 2017. North East also allegedly kept money that Medicare overpaid the medical transportation company, but North East denies these allegations as well.

The Medicare fraud settlement covers Maine Medical Center’s alleged paperwork falsehoods from October 2007 through March 2015.

Medicare Fraud Settlement to Avoid Court

North East responded to the Medicare fraud settlement by releasing a statement through a public relations company reaffirming that the ambulance service provider committed no wrongdoing. North East provided transportation at the request of Maine Medical Center’s personnel who indicated the ambulance rides were necessary and who were “acting in the best medical interest of the patient.”

North East’s prepared statement went on to say, “At the request of medical personnel, North East Mobile Health Services transported Maine Medical Center patients via ambulance to hospitals, skilled nursing facilities and other locations. In all instances, all providers were acting in the best medical interest of the patient and the required documentation from medical personnel certified the ambulance transports were medically necessary. As such, reimbursement claims were submitted to Medicare and processed. However, the medical necessity of some of these ambulance transports was subsequently contested.”

Maine Medical Center claimed an independent review of the hospital’s finances found no financial reward or monetary incentive from the alleged unnecessary ambulance trips, but Maine Medical Center declined to name the reviewer.

“Each case examined was based on medical necessity determined by a qualified medical provider,” the hospital said. “At all times, MMC acted with the best interests of patients in mind, making sure they had safe and reliable transportation following their treatment. We will continue to prioritize safe patient care and ensure that patients who have medical necessity receive access to ambulance services in a way that fully complies with legal and regulatory standards.”

Both the hospital and the ambulance service agreed that the Medicare fraud settlement would be less expensive than enduring a court battle over the allegations.

The office of U.S. Attorney Halsey B. Frank conducted the investigation and oversaw the Medicare fraud settlement.