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March 29, 2022

American Medical Response pays $600K settlement for overbilling

PHOTO | OFFICE OF ATTORNEY GENERAL WILLIAM TONG Attorney General William Tong
By Michelle Tuccitto Sullo

American Medical Response of Connecticut Inc. has paid $601,759 to resolve claims that it improperly billed Medicare and Medicaid for its services.

The payment is part of a civil settlement agreement with both the federal and state governments.

State Department of Public Health Commissioner Manisha Juthani said inaccurate billing processes will not be tolerated.

“Connecticut residents should rest assured that state and federal agencies are always on the watch and ready to collaborate in the investigation and prosecution of organizations whose business practices are not only unethical but illegal as well,” Juthani said, in a statement.

Both the U.S. Attorney’s office for Connecticut and state Attorney General William Tong announced the agreement Tuesday morning.

“Working in coordination with our state and federal partners, our office is prepared to take aggressive action against anyone who abuses our taxpayer-funded healthcare programs,” Tong said.

Officials claimed the company improperly billed for advanced life support (ALS) services in cases where it had actually only performed basic life support (BLS) services.

ALS is performed by a paramedic at the scene of an emergency response and in the ambulance, and requires a high level of medical monitoring.

In contrast, BLS services are for less acute cases, can be performed by a basic-level emergency medical technician, or relate to the transport of a patient via ambulance to a hospital or other medical facility.  

According to the government, throughout the state, local fire departments provide ALS emergency services following calls to 911.

American Medical Response (AMR) is typically dispatched to the scene of such calls to provide ambulance transport only, a BLS service.

If both the fire department and AMR are on scene together, it is considered a “joint response.”

Both federal and state officials alleged that AMR would often bill Medicare and Medicaid for the advanced paramedic services when it was actually providing ambulance transport.

Therefore, in many cases both AMR and local fire departments were billing for the advanced paramedic services. This caused the health coverage agencies to pay twice, once to the local fire department and once to AMR, according to a press release. 

The $601,759 settlement amount covers improper claims submitted to Medicare and Medicaid from January 2014 through December 2019, officials said.

AMR has also entered into a consent agreement with the state Department of Public Health. The company agrees to stop the prohibited conduct and pay a $25,000 civil penalty to the state of Connecticut. AMR must also comply with DPH quarterly reporting and compliance monitoring requirements for one year.

The company did not immediately respond to a request for comment.

Contact Michelle Tuccitto Sullo at msullo@newhavenbiz.com.


 

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