A South Carolina ambulance company, Williston Rescue Squad, Inc. ("Williston"), has agreed to pay the United States $800,000 to settle allegations that Williston billed Medicare for ambulance rides that were medically unnecessary in violation of the False Claims Act.
A clinical social worker at a facility that regularly receives Medicare patients transported by Williston initially made the allegations in a lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblower, Sandra McKee, alleged that Williston billed Medicare for routine, non-emergency ambulance transports and falsified documents to make the transports appear to meet Medicare requirements for reimbursement.
Medicare rules state that non-emergency ambulance services are only reimbursable if the Medicare patient is confined to bed or has a medical condition that requires transportation by ambulance (e.g., requires third-party assistance to administer oxygen en route; is morbidly obese and requires additional equipment or personnel to transport; is comatose.)
As her reward under the qui tam provisions of the False Claims Act, the whistleblower will receive approximately $160,000 of the settlement amount.