FYI

August 23, 2011

United States Attorney T. Jacks

Northern District of Texas

_______________________________________________________________________________

FOR

IMMEDIATE RELEASE MEDIA INQUIRIES: KATHY

COLVIN

TUESDAY, AUGUST 23, 2011

www.usdoj.gov/usao/txn

GOVERNMENT RECOVERS MORE THAN $1.6 MILLION FROM

ELEVEN CITIES TO RESOLVE ALLEGATIONS THEY

CAUSED IMPROPER MEDICARE AND MEDICAID AMBULANCE CLAIMS

DALLAS — The Texas cities of Plano, Frisco, ,

Mesquite, Celina, DeSoto, Corpus Christi, Cedar Hill, Rowlett, North

Richland Hills and University Park (collectively “Cities”) have agreed to

pay the U.S. and Texas the collective amount of $1.69 million to resolve

allegations they violated the civil False Claims Act and Texas Medicaid

Fraud Prevention Act, announced U.S. Attorney T. Jacks of the Northern

District of Texas. The U.S. and Texas contend all the Cities caused

“upcoded” claims to be submitted to Medicare and Medicaid for

city-dispatched 911 ambulance transports between 2006 and 2010. All the

Cities fully cooperated with the investigation, and by settling, did not

admit any wrongdoing or

liability.

Ambulance services generally are coded either as basic life

support level or advanced life support (ALS). ALS transports are reimbursed

at a higher rate by both Medicare and Medicaid. The U.S. and Texas contend

the Cities’ billing contractor coded 911-dispatched transports at the ALS

level, which indicates an ALS service was furnished and/or the patient’s

condition necessitated an ALS intervention. The U.S. and Texas allege the

Cities caused to be submitted for payment claims falsely representing to

Medicare and Medicaid that such ALS services were appropriate and furnished

by their personnel when in fact no ALS service was rendered and/or the

patient did not require an ALS

transport.

The U.S. and Texas initiated the investigation in response to a

February 2010 whistleblower suit brought by . Under the False

Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may

bring actions alleging fraud on behalf of the government and collect a share

of any proceeds recovered by the suit. Mr. can receive up to 30% of

the recovery under the settlement.

U.S. Attorney Jacks praised the efforts of the Office of

Inspector General of the U.S. Department of Health and Human Services and

the FBI.

The case was handled by Assistant U.S. Attorney McKenna,

Assistant Texas Attorney General Sinty Chandy and OIG Senior Counsel Ellen

Slavin. The case is captioned United States of America, et al. ex rel.

v. City of Cedar Hill, et al., Civil Action No. 3:10-cv-0233-O (N.D.

Tex.). Investigations of other defendants remain ongoing.

August 25, 2011

The glucometer.

The 454 was a gas engine.

>

> United States Attorney T. Jacks

> Northern District of Texas

>

_______________________________________________________________________________

>

> FOR

> IMMEDIATE RELEASE MEDIA INQUIRIES: KATHY

> COLVIN

>

> TUESDAY, AUGUST 23, 2011

>

> www.usdoj.gov/usao/txn

>

> GOVERNMENT RECOVERS MORE THAN $1.6 MILLION FROM

>

> ELEVEN CITIES TO RESOLVE ALLEGATIONS THEY

>

> CAUSED IMPROPER MEDICARE AND MEDICAID AMBULANCE CLAIMS

>

> DALLAS — The Texas cities of Plano, Frisco, ,

> Mesquite, Celina, DeSoto, Corpus Christi, Cedar Hill, Rowlett, North

> Richland Hills and University Park (collectively " Cities " ) have agreed to

> pay the U.S. and Texas the collective amount of $1.69 million to resolve

> allegations they violated the civil False Claims Act and Texas Medicaid

> Fraud Prevention Act, announced U.S. Attorney T. Jacks of the Northern

> District of Texas. The U.S. and Texas contend all the Cities caused

> " upcoded " claims to be submitted to Medicare and Medicaid for

> city-dispatched 911 ambulance transports between 2006 and 2010. All the

> Cities fully cooperated with the investigation, and by settling, did not

> admit any wrongdoing or

> liability.

>

> Ambulance services generally are coded either as basic life

> support level or advanced life support (ALS). ALS transports are reimbursed

> at a higher rate by both Medicare and Medicaid. The U.S. and Texas contend

> the Cities' billing contractor coded 911-dispatched transports at the ALS

> level, which indicates an ALS service was furnished and/or the patient's

> condition necessitated an ALS intervention. The U.S. and Texas allege the

> Cities caused to be submitted for payment claims falsely representing to

> Medicare and Medicaid that such ALS services were appropriate and furnished

> by their personnel when in fact no ALS service was rendered and/or the

> patient did not require an ALS

> transport.

>

> The U.S. and Texas initiated the investigation in response to a

> February 2010 whistleblower suit brought by . Under the False

> Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may

> bring actions alleging fraud on behalf of the government and collect a share

> of any proceeds recovered by the suit. Mr. can receive up to 30% of

> the recovery under the settlement.

>

> U.S. Attorney Jacks praised the efforts of the Office of

> Inspector General of the U.S. Department of Health and Human Services and

> the FBI.

>

> The case was handled by Assistant U.S. Attorney McKenna,

> Assistant Texas Attorney General Sinty Chandy and OIG Senior Counsel Ellen

> Slavin. The case is captioned United States of America, et al. ex rel.

> v. City of Cedar Hill, et al., Civil Action No. 3:10-cv-0233-O (N.D.

> Tex.). Investigations of other defendants remain ongoing.

>

August 25, 2011