Officials with an Eastern Kentucky ambulance service admitted Tuesday that they took part in submitting false bills to get payments from Medicaid and Medicare.
Hershel Jay Arrowood, who owns Arrow-Med Ambulance in Breathitt County; his wife, Lesa Arrowood, who handled billing; and Terry Herald, who was a manager at the company, pleaded guilty to health care fraud, according to court records.
The company also pleaded guilty.
A federal grand jury charged last year that the three individuals and the company schemed to bill taxpayer-funded health plans for transporting people for treatment when it wasn’t medically necessary for them to go by ambulance.
Medicare will pay for non-emergency ambulance runs, but only in cases in which it is medically necessary, such as when patients can’t walk.
The indictment charged that Jay Arrowood told ambulance workers at his company to not make a record of the fact that patients could walk to and from the ambulance.
Lesa Arrowood allegedly told employees to include false information about patients’ conditions on the run sheets, and Terry Herald falsified run sheets or caused others to do so, the indictment said.
In a related civil lawsuit, the government included an example of a woman who went for treatment aboard an Arrow-Med ambulance, but was able to walk from the ambulance up a steep driveway without help.
The indictment listed more than a dozen cases in which Arrow-Med allegedly filed claims of $1,800 for taking people to dialysis or other treatment when ambulance transportation was not necessary.
Arrow-Med received a total of $249,539 in payments from Medicare and Medicaid from late 2012 through August 2015 for just two patients covered in the company’s plea, according to a court document.
The company and Jay and Lesa Arrowood are liable for repaying that amount under the plea deals.
The couple and Herald face up to 10 years in prison. They are to be sentenced in October.