The settlement resolves allegations by the United States and Tennessee that First Call up coded billings for ambulance transports provided to patients covered by federal healthcare programs and TennCare, Tennessee’s joint state/federal Medicaid program.
Specifically, the United States and Tennessee alleged that First Call submitted false claims for payment covering advanced life support services for its ambulance runs. For many transports billed as ALS, First Call’s provision of ALS services was medically unnecessary, or First Call did not actually provide ALS services. Instead, only basic life support services were necessary, and in some cases were the only services provided. BLS services are billed to federal health insurance programs at a lower rate than ALS services.
“Enforcement of the False Claims Act remains a top priority of the Department of Justice and this office,” said Rivera. “The U.S. attorney’s office, working with our law enforcement partners, will continue to devote the resources necessary to vigorously protect taxpayers’ interests and aggressively pursue fraud, waste, and abuse.”
In addition to the monetary payment, First Call has entered into a corporate integrity agreement with the U.S. Department of Health and Human Services. This agreement will require First Call to take certain compliance measures to reduce the likelihood of future violations of the FCA and other health care regulations.
The federal and state investigations corroborated conduct originally alleged in a qui tam complaint filed pursuant to the FCA. The United States and Tennessee declined to intervene with regard to other allegations in the qui tam complaint. The relator who filed the qui tam will receive a share of the settlement proceeds.
The U.S. Postal Service Office of Inspector General, Tennessee Bureau of Investigation, Tennessee Attorney General’s Office and the U.S. Attorney’s Office for the Middle District of Tennessee investigated the case. U.S. attorney Christopher C. Sabis served as prosecutor.