The federal government has joined a complaint alleging that a Breathitt County ambulance service billed Medicare and Medicaid for medically unnecessary ambulance runs.
Arrow-Med Ambulance took people to a dialysis clinic and other appointments even though they didn’t need to go by ambulance, then submitted false information to get payments for the runs, federal attorneys said.
Company owner Hershel Jay Arrowood told ambulance crews not to say in paperwork that patients could walk, while Lesa Arrowood, who handled billing, told employees to falsify information, the lawsuit said.
The fraudulent claims resulted in a loss to Medicare and Medicaid of more than $1 million, the government said in its claim.
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The claim against Arrow-Med started last year with a lawsuit against the company by Darrell Stephen McIntosh, who owns a competing ambulance service.
McIntosh sued under the federal false claims act, which allows whistleblowers acting on behalf of the government to be paid for uncovering fraud involving a federally funded program.
The federal government can intervene in such complaints. That’s what has happened in the case against Arrow-Med.
Arrow-Med’s attorney, Scott White, said Tuesday the company has done nothing improper. Arrow-Med hired a consultant for advice on complying with the law, and all its ambulance runs were based on a doctor’s order, White said.
McIntosh is trying to run Arrowood’s company out of business, White said.
“We cannot wait to get him under oath to back up these allegations. I’m betting he can’t,” White said.
The government’s complaint, filed June 3, said Arrow-Med “systematically” defrauded Medicare and Medicaid through thousands of illegitimate reimbursement claims between September 2012 and August 2015.
The document said a federal contractor checked 20 claims from Arrow-Med in mid-2013 after they’d been paid and found none of them justified reimbursement because the people didn’t need to be transported by ambulance.
That contractor began requiring Arrow-Med to submit paperwork from ambulance runs to be checked before payment.
The “most egregious” examples of the company falsifying ambulance-run sheets started after that, the lawsuit alleged.
The complaint cited several examples of ambulance trips that were allegedly not medically necessary.
In November 2012, for instance, Arrow-Med took a woman identified as J.B. for dialysis treatment and then back home, even though her medical assessment said she liked walking and cooking and walked half a mile daily for exercise, the lawsuit said.
In June 2015, Arrow-Med took J.B. home from the clinic, but she walked up a steep gravel driveway unassisted when she got there, the complaint said. Arrow-Med received $479.76 for that trip.
The same month, Arrow-Med took a patient identified as D.D. for dialysis. The company reported employees carried him from the ambulance to bed, when in fact he walked, the complaint said.
The company received $145.65 for taking D.D. to the clinic and the same amount for taking him home, the lawsuit said.
Paramedics and emergency medical technicians working for Arrow-Med told Jay and Lesa Arrowood many of the ambulance runs were not necessary, according to the government complaint.
The lawsuit seeks damages of three times the loss to the government, plus repayment of any money obtained by fraud and a fine of at least $5,000 for each instance of wrongdoing.