An ambulance service in Lee County defrauded taxpayer-funded health programs by submitting false claims for payment, the federal government alleged in a lawsuit filed Friday.
The service put information in reports that made it seem patients were in worse condition than they really were, so that the runs would qualify for federal reimbursement, the lawsuit charged.
Staffers also altered dates and forged doctors’ names on forms included in reimbursement claims to Medicare and Medicaid, the lawsuit said.
The lawsuit is against the county fiscal court, which operated Citizens of Lee County Ambulance Service, and the director, Joseph R. Broadwell.
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That service stopped operating in June 2016. Lee County then contracted with an ambulance company in neighboring Breathitt County to provide service in Lee County, said Lexington attorney Mark Wohlander, who represents Lee County.
Wohlander said the lawsuit has the potential to end Lee County’s ability to provide ambulance service if the federal government gets a substantial judgment.
Potential damages in the case total in the millions, he said.
“The county doesn’t have that money,” Wohlander said.
Wohlander said the county and Broadwell deny engaging in any fraudulent activity.
The lawsuit is without merit, based on decisions about what services are medically necessary by people with no medical training, said Wohlander, a former assistant federal prosecutor.
In a case involving similar allegations, three officials with Arrow-Med Ambulance in Breathitt County pleaded guilty in July to taking part in submitting false bills to public health programs.
The lawsuit against the Lee County ambulance service is a civil matter, not criminal.
The lawsuit said the county began operating the ambulance service in October 2001, and Broadwell came on as manager in 2008.
The complaint focuses on cases in which the ambulance service allegedly provided transportation to people when that was not medically necessary.
Medicare and Medicaid reimburse ambulance services for non-emergency runs, with some limits.
One is that Medicare is not supposed to pay for non-emergency runs when transporting a person by another means, such as by private vehicle, would not endanger the person’s health, according to the lawsuit.
Medicare also won’t pay for non-emergency, repetitive transports — such as those for dialysis treatment — without prior authorization from a doctor.
The complaint charged that the Lee County ambulance service took people to dialysis treatments when they didn’t really need an ambulance.
One patient, for instance, was a member of the local rescue squad and a volunteer firefighter who routinely responded to emergencies, showing he did not have a medical condition that required the ambulance service to transport him to dialysis treatments, the lawsuit argued.
The man’s doctor would not sign an order for the medical transports because he did not believe they were required, the lawsuit said.
Still, the ambulance service took the man for dialysis treatments and billed the government for the runs, the lawsuit said.
After the service closed, the man’s wife drove him to treatments, according to the lawsuit.
The complaint highlighted another person who received ambulance transports but could walk.
The woman’s doctor approved ambulance transports for her, saying she had no other options to get to treatment.
However, lack of alternative transportation does not make ambulance transport medically necessary, the lawsuit said.
The company that handled billing for the ambulance service raised concerns on occasion that some ambulance runs for dialysis patients did not qualify for reimbursement, the lawsuit said.
In response, Broadwell had an employee post guidelines on what to put on run sheets, including “do not document that the patient walked” from the ambulance to the office, the lawsuit said.
In late 2015, employees told Broadwell they thought dialysis transports were unnecessary and would cause the ambulance service to violate federal rules.
“Broadwell responded that the dialysis patients were the ‘bread and butter’ of Lee County Ambulance and that transportation of each would continue,” the lawsuit said.