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Tennessee False Claim Act Case Yields Ambulance Service Pays $500,000

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Tennessee False Claims Act Yields $500,000 Settlement by Ambulance Company

As a Tennessee False Claims Act attorney, I am pleased to report that First Call Ambulance Services paid $500,000 in May 2014 to settle a Tennessee False Claims Act lawsuit, alleging improper billing by the medical transport company. The undisclosed whistleblower is allowed to receive up to 30 percent of the amount in recognition of his initiative that led to a fraud investigation by federal and state authorities and recovery of Medicaid funds. The qui tam lawsuit is the latest in a series of hundreds of such whistleblower actions encouraged and protected under the Tennessee Medicaid False Claims Act, leading to reclaiming of embezzled taxpayers’ money running into millions of dollars.

The Ambulance False Claims Act Lawsuit

A Tennessee whistleblower approached the court accusing First Call Ambulance Services of upcoding and submitting false bills to claim money from state and federal Medicaid fund. According to the qui tam lawsuit filed as per the Tennessee Medicaid False Claims Act, First Call made fake claims claimed to have provided advanced life support to patients during medical transport to claim higher amounts while patients were provided much cheaper basic life support while on the ambulance. Our firm has successfully handled upcoding cases involving the Tennessee False Claims Act.

A probe by the U.S. Attorney’s Office for the Middle District of Tennessee and the Tennessee Bureau of Investigation following the whistleblower false claim lawsuit found First Call guilty of submitting up-coded bills. The TN false claim act lawyer representing the submitted evidence to highlight that First Call billed many patients “who plainly did not need to be transported by ambulance or were able to walk to the vehicle and enter unassisted” for advanced life supports.

While advanced life support was not offered in most cases as claimed and only basic life support was administered. There are many instances where extensive resuscitation efforts was claimed to be provided to patients, who did not have any kind of require life support on their way to hospital. Advanced life support involves extensive medical care and resuscitation efforts and hence is more expensive than basic life support services.

Tennessee False Claims Act: What is Upcoding

Upcoding refers to making a misleading claim for reimbursement for medical services more expensive than those performed. Each medical procedure has been assigned current procedural terminology or a code, which was quoted in the bill by healthcare provider and professionals when submitted for Medicaid or insurance reimbursement. When bills are submitted, higher or lower amount of payment is done based on these codes.

Many seeking reimbursements make fraudulent claims by mentioning codes of higher-paying care than those actually rendered. There may be a bill mentioning code for ultrasound or MRI, the actual service was just a quick check up.

A Tennessee False Claim Act Lawsuit

Tennessee Medicaid False Claims Act recognizes upcoding as one of the fraudulent practices punishable with monetary penalty. Anyone found involved in submitting up coded bills is likely to be fined three times of the money embezzled along with $25,000 in penalty. The Medicaid False Claims Act rewards whistleblowers filing qui tam lawsuits with up to 30 percent of the total money recovered from the accused.

Healthcare false billing and upcoding are common occurrences addressed by the Tennessee False Claims Act. If you have any evidence to expose any such fraud, contact an expert False Claims Act attorney to discuss your options whistleblower or qui tam actions.

To Contact a Tennessee False Claims Act Today

We help whistleblowers on a contingency basis, meaning there is no fee charged for our work unless there is a recovery. We also front any and all expenses. No matter where you are located — we will represent you. We will come to you, you will not have to come to us. Attorneys in our firm and attorneys that we work with on Whistleblower, Qui Tam, False Claims Act cases have represented a host of persons making claims, for violations of federal tax law, Medicare law and more. For more information, please contact our team of whitsleblower and qui tam attorneys today.

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    Hospiutal Settled Tennessee False Claims Act Lawsuit for $9,250,000.00

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    Tennessee False Claims Act Settlement

    As a Tennessee False Claims Act lawyer, I am very pleased to report that CRC Health has agreed to pay $9.25 million ($9,250,000.00) to settle claims brought against it under the necessary provisions of the Tennessee Medicaid False Claims Act. A former employee of the group, a subsidiary of Bain Capital, had accused one of its addiction treatment facilities in Tennessee of defrauding the Medicaid money by making false claims for reimbursement and offering substandard services to inmates. Angela Cederoth, the whistleblower, is set to receive compensation amounting to $1.25 million for his role in helping the recovery of misappropriated TennCare funds.

    According to the whistleblower, New Life Lodge Facility, a substance abuse treatment and rehab center run by CRC Health in Burns, misappropriated millions of dollars between 2006 and 2012 by not providing assured minimum standard of substance abuse therapy. The hospital did not engage well-trained and licensed therapists to treat addiction patients at the hospital to ensure maximum profit. Most of the employees tasked with taking care of inmates were not qualified as per the Tennessee law.

    The principle of “medical necessity” was violated with failure to have

    “New Life Lodge accepted millions of dollars of TennCare funds with the understanding that it would provide necessary substance abuse treatment services to some of the State’s most vulnerable citizens, but far too often those operating the facility failed to meet their obligations by falling short of minimum necessary standards of care or using third-party pharmacies to double-bill the program,” alleges the TN Medicaid false claim lawsuit filed in against CRC Health.

    The facility was accused of engaging in double-billing to get higher payments from TennCare. It allowed admission of more patients than its stated capacity to ensure more profit, but failed to have the appropriate staff to patient ratio. Third-party pharmacies were roped in to make double billing for substance abuse medications and false bills were submitted for services not provided. Many of the services billed for were never documented.

    Of the $9.25 million settlement, the State of Tennessee is set to receive $3.4 million while the qui tam plaintiff is awarded a whopping $1.25 million for help in recovering state funds. The rest of the amount is to be deposited with the federal government.

    Tennessee Medicaid False Claims Act

    The Tennessee Medicaid False Claims Act enacted in 1993 allows necessary civil action by qui tam plaintiffs to highlight defrauding of TennCare funds and recover the conned money along with penalty. A TennCare fraud whistleblower can proceed with the state prosecution on his own with a qualified TN false claim attorney seeking return of the defrauded Medicaid funds on behalf of the state. He is assured of legal protection and financial award for his role in retrieving the public money.

    AIM Healthcare Services agreed to settle a litigation filed invoking the Tennessee Medicaid False Claims Act in February 2014. Accused of pocketing TennCare funds by making false bills, the group paid close to $800,000, of which the whistleblower received over $100,000 as reward.

    According to report, qui tam relators had helped state and federal governments to recover over $3 billion duped by false billing, upcoding, and other fraudulent practices in 2013. Of the 846 lawsuits filed last year, whistleblowers and their false claim attorneys played a vital role in 89 percent of litigations leading to retrieval of embezzled public money.

    To Contact a Tennessee False Claims Act Lawyer

    We help whistleblowers on a contingency basis, meaning there is no fee charged for our work unless there is a recovery. We also front any and all expenses. No matter where you are located — we will represent you. We will come to you, you will not have to come to us. Attorneys in our firm and attorneys that we work with on Whistleblower, Qui Tam, False Claims Act cases have represented a host of persons making claims, for violations of federal tax law, Medicare law and more. For more information, please contact our team of whitsleblower and qui tam attorneys today.

    CALL 1-800-632-1404

    or fill out this form below for a free initial consultation.

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      Case Details

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      Our offices will review potential false claims act cases in all fifty states, including Tennessee, Arkansas, Mississippi, Kentucky and Alabama.