JACKSONVILLE, Fla. – Two recently unsealed lawsuits assert two major ambulance providers in Jacksonville knowingly overcharged the federal government and state of Florida millions of dollars in Medicare and Medicaid payments.
The lawsuits were filed by a man who worked for both Liberty Ambulance and Century Ambulance in Jacksonville and also named four major Northeast Florida hospitals, which said they have settled out of court.
An emergency medical technician named Shawn Pelletier worked at Century Ambulance from 2004 to 2006 and at Liberty Ambulance from 2007 to 2009.
In lawsuits filed over the past few years and just unsealed days ago, Pelletier said the ambulance companies and hospitals knowingly defrauded the federal government by transporting patients who didn't need it, then billing Medicare and Medicaid.
Both suits named UF Health Hospital (or Shands), Baptist Health, Memorial Hospital and Orange Park Medical Center.
The suit against Century said the company had a "regular practice of falsifying documents and records with the purpose of billing Medicare or Medicaid for ambulance services."
The Liberty suit said, "In order to create the appearance that it has performed a BLS (basic life support) level of service and complied with Medicare requirements -- and to get its false claims paid -- Liberty Ambulance systematically falsifies its 'patient care report' to reflect clinical characteristics that were not present and medical treatment that was never performed."
Gene Nichols, an attorney not affiliated with the case, said such suits are usually unsealed when at least one of the parties has not agreed to settle.
"What we most likely had in this case was it sealed for an extended period of time to have the investigation, have it complete, let the federal government find out whether they want to be a part of this," Nichols said.
Pelletier is suing on behalf of the United States -- and taxpayers – who are essentially the victims in the case because the money came from Medicare and Medicaid. The suits cite the federal False Claims Act, saying Pelletier has the right to sue on behalf of the government.
The president of Liberty Ambulance, which has not agreed to settle with the government, said, "We believe unequivocally that we are innocent of any intent to defraud anyone, including the federal government. And as a faith-based business we've always operated at what we feel is a higher level and morality level that probably not all businesses have. So it's a little bit of an insult to us."
The CEO of Century Ambulance said he couldn't comment other than to say, "We are cooperating with state and federal agencies to resolve this case."
Several of the hospitals in the case released statements to News4Jax.
Baptist Health said: "We have fully cooperated with the government's investigation, but in our judgment, we have done nothing wrong. We don't provide ambulance services, nor do we bill for them. Our focus is on patient safety, including the safe transport of our patients after discharge. We deny the allegations made against us in the whistleblower complaints."
The statement from Memorial Hospital said: "Patient safety and quality continue to be our number one priorities at Memorial Hospital. We understand how important patient safety is to our patients and their families and we remain committed to providing high quality care in a safe and caring environment. In the determination of when ambulance transport post-discharge is medically necessary, our goal is to do what is best for our patients based on proper assessment of their condition, but there are complex Medicare rules that govern the appropriateness of when ambulance companies may bill for such transport if the patient is deemed well enough to travel in a cab or van. This case addresses that issue for certain former Medicare patients, and we are pleased the matter is being resolved."
UF Health Jacksonville said it "has reached a settlement involving transportation services provided by outside companies.
It also said, "It is important to note that UF Health Jacksonville did not receive any payments for transportation or ambulance services and did not charge federal payors for any services, which were central to the lawsuit. UF Health Jacksonville only makes requests for transportation services. As a condition of the settlement, UF Health Jacksonville has not admitted to any wrongdoing or violation of applicable laws but has agreed to provide additional guidance and education to employees involved in requesting ambulance services."