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Medicare Fraud, Whistleblowers and Steps to Reduce False Claims Act Risk

Tuesday, May 09, 2017 12:00 PM | PAAW Administrator (Administrator)

EMS Live in Wisconsin Podcast

Ways to avoid unintended consequences in billing compliance.

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This podcast episode was recorded on May 9 and was dedicated to discussing Medicare Fraud, whistleblower protection and steps to reduce your False Claims Act risk. 

Recently, Madison attorney Wendy Arends with Godfrey & Kahn authored an article involving a $12.7 million settlement in a whistleblower Medicare fraud case against MedStar Ambulance in Massachusetts.  The former billing manager was the whistleblower in this case and reported the wrongdoing.

MedStar Ambulance is alleged to have: (1) billed for transports that were not medically reasonable and necessary; (2) billed for higher levels of services than patients’ conditions necessitated; and (3) billed for higher levels of services than were actually provided.

Besides the MedStar case, we also discussed how to reduce an ambulance service's Fraudulent Claims Act risk with internal policy and procedures, to include policies that address:  conducting internal audits and monitoring, designating a compliance officer, a process to investigate potential violations or patient complaints, whistleblower protection, etc.  Even if your ambulance service uses a third-party billing company to process runs, code them and bill Medicare, it doesn't release you as the ambulance company from liability, compliance, completing audits and any unintended consequences that may arise.

In addition to Wendy Arends as our guest we were also joined by Tom Tornstrom, Executive Director at Tri-State Ambulance in La Crosse, who offered some excellent points, to include Chapter 10 (Ambulance Services) of the Medicare Benefit Policy Manual that every ambulance service director should read.

>> Click to download Wendy's article regarding the MedStar Ambulance Medicare fraud settlement case.

>> Click to download Medicare Benefit Policy Manual - Chapter 10 (Ambulance Services).

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>> Click for on-demand playback and listen now!


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