Preet Bharara, the United States Attorney for the Southern District of New York, and Scott J. Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s New York Region (“HHS-OIG”), announced today that the United States has settled civil claims under the False Claims Act against the City of New York (the “City”) related to the receipt by the New York City Fire Department (“FDNY”) of reimbursements for claims for emergency ambulance services that did not meet Medicare’s medical necessity requirement. This matter was brought to the attention of the U.S. Attorney’s Office through a voluntary disclosure by the City.
Manhattan U.S. Attorney Preet Bharara said: “For the Medicare program to function properly and fairly, it is essential that providers be reimbursed only for those services that are covered. For more than four years, the New York City Fire Department received reimbursements for emergency ambulance services that did not meet Medicare’s requirements. We appreciate that the City of New York brought this to our attention, and we believe this settlement to be an appropriate resolution of the problem.”
HHS-OIG Special Agent in Charge Scott L. Lampert said: “HHS-OIG is committed to protecting the Medicare program and the taxpayers who help fund it. This settlement will help ensure that our federal health care programs are utilized properly so they continue to serve those who need them most.”
The FDNY, through its Bureau of Emergency Medical Services, provides emergency ambulance services throughout the City, including to patients eligible for Medicare. FDNY ambulances are dispatched in response to 9-1-1 calls for emergency medical assistance. To receive payment for emergency ambulance services provided to patients eligible for Medicare, the FDNY, through its ambulance billing contractor, submits claims to Medicare containing required information about each service. Emergency ambulance services for patients eligible for Medicare are only reimbursable from Medicare if those services meet Medicare’s medical necessity requirement.
As alleged in a complaint filed on Tuesday, May 3, 2016 in Manhattan federal court, between October 2008 and October 2012, the City consistently received reimbursements for tens of thousands of claims submitted to Medicare for emergency ambulance services that the City had identified as not meeting the Medicare medical necessity requirement. The City was aware that Medicare was paying reimbursements for these claims, but did not take steps to inform Medicare of the reimbursements for more than four years.
In the settlement, approved yesterday by United States District Judge Edgardo Ramos, the City agreed to pay $4.3 million and admitted and accepted responsibility for the following:
- From October 2008 through and including October 2012, the FDNY, through its ambulance billing contractor, submitted claims to Medicare for reimbursement for emergency ambulance services. As part of the claim submission process, the FDNY made assessments as to whether the emergency ambulance services associated with each claim met the Medicare medical necessity requirement.
- During this time period, the FDNY determined that thousands of claims for emergency ambulance services did not satisfy the Medicare medical necessity requirement, and provided information in the claims reflecting that determination to a Medicare Administrative Contractor as part of the claim submission process.
- During this time period, the FDNY consistently received reimbursements from Medicare for claims submitted to Medicare for emergency ambulance services that FDNY had identified as not meeting the Medicare medical necessity requirement.The FDNY was aware that Medicare was consistently paying the FDNY for such claims, but did not take steps to inform Medicare of its consistent receipt of Medicare reimbursement for such claims until December 2012.
- Beginning in or around September 2013, the FDNY modified its claiming procedures to reduce the risk that the FDNY would be improperly reimbursed for claims for emergency ambulance services that were not medically necessary.