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Mathias-Baker EMS pays $1M to resolve allegations

November 17, 2011
The Inter-Mountain

BAKER - U.S. Attorney William J. Ihlenfeld II recently announced that Mathias-Baker EMS in Baker has paid $1,068,717.56 to the United States to settle allegations that it submitted false claims for payment to the Medicare and Medicaid Programs.

The settlement agreement ends an investigation into allegations that the agency submitted false claims to Medicare and Medicaid for non-emergency ambulance transports from May 2008 to January 2010, in that the patients in question were being taken to and from routine medical appointments even though their medical conditions did not require ambulance transport.

Ambulance transport providers are charged with assuring that a Medicare beneficiary or Medicaid recipient meets the medical necessity requirements before submitting a claim seeking reimbursement for an ambulance transport. The Medicare and Medicaid programs will not pay for expensive ambulance transports when less costly means of travel can and should be utilized.

"Billing programs such as Medicare and Medicaid for services that are medically unnecessary is fraudulent and will not be tolerated. My office will continue to aggressively pursue any individual or business that schemes to profit from our health care benefit programs in order to protect both taxpayers and as well as those who truly need medical services," Ihlenfeld said in a news release.

"Today's settlement is still another example of our dedication to protecting taxpayers and government health care programs," said Maureen Dixon, assistant special agent in charge for the federal Health and Human Services Department, Office of Inspector General's region covering West Virginia. "Federal and state law enforcement agents will work shoulder-to-shoulder to investigate and prosecute these schemes."

This matter was handled by Assistant U.S. Attorney Alan G. McGonigal, in coordination with the United States Department of Health and Human Services, Office of Inspector General; the West Virginia Medicaid Fraud Control Unit; and the West Virginia Department of Health and Human Resources.



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