Lee County will pay $253,930 to the federal government to resolve allegations that its ambulance service submitted false bills for transporting patients on medically unnecessary runs, according to the federal prosecutor for the eastern half of Kentucky.
With that agreement and others, the government will recoup a total of $515,000 in connection with allegations that the ambulance service submitted false bills to Medicare and Medicaid, U.S. Attorney Robert M. Duncan Jr. said in a news release.
The earlier settlements were with an official from the ambulance service and the company that handled its billing. The latest was with the county fiscal court and Joseph Broadwell, former director of the Lee County Ambulance Service.
The government charged in a lawsuit filed last year that the county-owned service had put false information in reports to make it appear that patients were sicker than they really were, so that the ambulance runs would qualify for federal reimbursement.
Employees also allegedly altered dates and forged doctors’ names on paperwork seeking reimbursement from taxpayer-funded health programs.
Medicare and Medicaid will pay ambulance services for non-emergency runs in some cases, but not when a patient can be safely transported without an ambulance.
The government’s lawsuit charged that the Lee County Ambulance Service took people to medical appointments when they could walk and didn’t really need an ambulance.
The ambulance service allegedly submitted more than a thousand false claims for unnecessary ambulance runs between January 2013 and June 2016.
“Unfortunately, this conduct represents another example of a common ambulance service scheme, one where Medicare pays hundreds of thousands of dollars to transport patients who simply had no need for an ambulance,” Duncan said in a news release. “No matter who submits them, the payment of false or fraudulent claims damages the public and reduces the limited tax dollars available to pay legitimate claims intended to help program recipients.”
Mark Wohlander, a Lexington attorney who represented Lee County, said the county faced millions of dollars in potential damages.
The county was “well pleased” to settle the case for a fraction of that, Wohlander said.
The case is one of several in Eastern and Southern Kentucky in which ambulance services or other health providers have been accused of billing Medicare for unnecessary services in order to make money.
In neighboring Breathitt County, three people associated with Arrow-Med Ambulance pleaded guilty to health fraud.
A federal judge sentenced Arrow-Med owner Hershel Jay Arrowood to serve a year and a day in jail, and the company agreed to repay $249,539.
Lee County’s ambulance service stopped operating in June 2016.
The fiscal court has since contracted with a company in Breathitt County to provide ambulance service in Lee County.
Lee County Judge-Executive Charles “Chuck” Caudill Jr., a Republican who took office at the first of the year, said it can take an hour or more for an ambulance to respond under the current arrangement.
Caudill is pursuing a plan to address concerns over ambulance service by having the Middle Kentucky Community Action Partnership take over management of Lee County’s service, and perhaps others in its area.
The agency serves Lee, Wolfe, Breathitt and Owsley counties.
Adequate ambulance service is a must, Caudill said.
“I see it as a quality of life issue,” he said. “ I see it as an economic development issue.”