The biggest provider of ambulance services in Tampa, Florida entered an agreement with the US government this week to settle allegations that it violated the False Claims Act (FCA). In a statement on January 30, the Department of Justice said the AmeriCare Ambulance Service, Inc. and its sister company, AmeriCare ALS, Inc. (collectively, AmeriCare), have agreed to pay around $5.5 million to resolve claims that it defrauded Medicare by billing for medically unnecessary ambulance transportation services.
The settlement concludes a lawsuit first filed by Ernest Sharpe, a former paramedic in AmeriCare. He filed the lawsuit in 2013 under the qui tam, or whistleblower, provisions of the False Claims Act that permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The Act also allows the government to intervene and take over the action, as it did in this case in 2017. Mr Sharpe as whistleblower will receive roughly $1.15 million of the $5.5 million recoveries from AmeriCare. Whistleblower awards have skyrocketed over the last decade as the government is clamping down on health care fraud and handsomely giving qui tam awards to people who blow the whistle in the correct manner. To blow the whistle under the False Claims Act, one needs a whistleblower lawyer, preferably one experienced in combatting Medicare Fraud.
Based on Sharpe’s lawsuit and the complaint subsequently filed by the US government against AmeriCare, the latter had allegedly engaged in a systemic practice – over many years – of submitting fraudulent claims to the government. With the whistleblower, the government investigators amassed damaging testimonies from members of AmeriCare’s management team. These, along with other evidence obtained by the government, reportedly showed that from January 2008 through December 2016, AmeriCare fraudulently billed Medicare and TRICARE. They also found out that AmeriCare had produced thousands of false reports and other documentation during this period, to prop up the claims to Medicare.
Although the settlement states that the allegations against AmeriCare remain as such, it agreed to pay around $5.5 million and allowed itself to enter into an integrity agreement with the Inspector General of the U.S. Department of Health and Human Services. Whistleblower Attorney Jason T. Brown commented, “This is another excellent result obtained by the government with the assistance of a whistleblower and private qui tam counsel. The companies rarely admit guilt, but the money speaks volumes.”
US Attorney Chapa Lopez said the lawsuit and the week’s settlement speak for the office’s ongoing efforts to safeguard federal health care program beneficiaries from the effects of this type of unlawful conduct. The DOJ highlighted the government’s efforts against health care fraud, where it considers the help of whistleblowers under the False Claims Act as one of their most powerful tools.
Although the settlement resolves the case, it did not say that AmeriCare has been determined as liable. The claims against in remain as allegations. The case is captioned United States, et al. ex rel. Sharpe v. AmeriCare Ambulance, Case No. 8:13-cv-1171-T-33AEP.
The settlement resulted from the coordinated effort of the U.S. Attorney’s Office for the Middle District of Florida and the HHS-OIG and the Defense Criminal Investigative Service. Assistant United States Attorney Christopher P. Tuite handled the case.