Florida Hospitals Pay $7.5M for Medical Billing Fraud

There are allegations of fraudulent billing and other practices against 9 hospitals in Florida with an ambulance service provider that occurred between January 2009 and April 2014. The hospitals involved in the False Claims Act case will pay a total of $7.5 million to settle allegations investigated by the US Department of Justice, the Federal Bureau of Investigation, and other agencies.

Shawn Pelletier, a former employee of Century Ambulance Services, Inc., brought attention to the healthcare fraud and will receive more than $1.2 million for identifying the case. Pelletier's lawsuit under the False Claim Act alleges that the hospitals ordered ambulance transfers via Century that were medically suspect, causing the government healthcare services millions in unnecessary billings. The hospitals routinely ordered life support ambulance transfers that have since been deemed medically unnecessary. Furthermore, Century was also accused of knowingly up-coding claims from basic to life support. Additionally, Century was accused of transporting patients unnecessarily and needlessly driving patients to their own homes as if it were an emergency.

Summary by Caroline Smith

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Caroline Smith is currently a senior at the University of Notre Dame and is a contributor to Medical Groups.  She is majoring in Science-Business and Spanish. After graduation, Caroline plans on entering the field of healthcare consulting. She is most interested in the evolving policy changes in the healthcare industry and enjoys learning about new technologies that are being developed.