The United States federal government has become involved in an EMS whistleblower lawsuit, with various False Claim Act (FCA) violations being alleged against AmeriCare Ambulance Service Inc.

The EMS whistleblower lawsuit was filed by a former paramedic who alleged the healthcare company had submitted false claims for non-emergency ambulance transports. These transports were reportedly not medically necessary, with the claims earning the company millions in reimbursements from federal programs.

The federal government recently completed its investigation into the claims made in the EMS whistleblower lawsuit, after deciding to get involved with the investigation in learning about the alleged FCA violations by AmeriCare Ambulance Service.

The EMS whistleblower lawsuit is being filed by Ernest Sharpe, who reported the company had billed the federal government on a regular basis for allegedly unnecessary ambulance transportation rides while creating fictitious reports to justify the claims.

“These statements were false because they did not accurately reflect the patient’s condition and other material information. To be sure, these statements were not the result of mere negligence. [I]nstead, AmeriCare encouraged, coached, induced and/ or instructed its employees and others to use words or phrases on relevant documentation that would justify reimbursement, and to omit words and phrases that would make reimbursement less likely,” the EMS whistleblower lawsuit states.

Overview of EMS Whistleblower Lawsuit

Sharpe had originally filed the EMS whistleblower lawsuit under seal in May 2013, reporting he had witnessed AmeriCare commit fraud multiple times during his five month employment span. Sharpe was reportedly fired soon after reporting the alleged fraud.

AmeriCare Ambulance Services Inc. provides ambulance services to Medicare and Medicaid patients in a few counties in Florida, and is only supposed to submit claims for medically necessary ambulance rides for patients.

In order to be eligible for compensation for non emergency purposes, Medicare and Medicaid require beneficiaries to be “bed confined” and unable to move without assistance. Sharpe alleged he was trained to write reports that would justify reimbursement claims to Medicare, by categorizing patients as bed confined even if they were not.

Sharpe soon began conflicting with management over the alleged fraud, which eventually resulted in him reporting the company to the Florida Agency for Health Care Administration. Sharpe was fired just four days later, with the company falsely accusing him of stealing company files and sabotaging its computer network system.

The United States government initially chose not to get involved, but allowed the investigation to continue. Shortly after the EMS whistleblower lawsuit was unsealed, AmeriCare tried to dismiss the case. It was then the federal government decided to get involved.

After U.S. District Judge Virginia M. Hernandez Covington decided to grant the dismissal notion, stating Sharpe did not prove the company’s alleged scheme and fault claim submissions were related. When the government expanded their investigation, however, AmeriCare supposedly submitted thousands of false claims to Medicare and Tricare from 2008 to at least 2016.

This allegedly resulted in millions in undeserved reimbursement payments. The EMS whistleblower lawsuit is seeking multiple damages and civil penalties, along with any other relevant monetary relief.

The EMS whistleblower lawsuit is United States of America v. AmeriCare Ambulance Service Inc., Case No. 8:13-cv-01171, in the U.S. District Court for the Middle District of Florida.