A Bangor ambulance service has agreed to pay $138,285 to settle allegations that it improperly charged the federal Medicare program for transporting patients discharged from Northern Light Eastern Maine Medical Center by ambulance when they didn’t need the emergency service.
The alleged trips by Northern Light Medical Transport — which happened between October 2016 and February 2018 when the group was still called Capital Ambulance — violated the federal False Claims Act, U.S. Attorney Halsey Frank said. The complaint did not identify how many alleged violations happened during that time.
Frank also said that EMMC staff provided incorrect or incomplete forms to certify the medical necessity of ambulance rides for their patients.
Federal authorities conducted their own investigation after Capital Ambulance independently reviewed its ambulance runs from EMMC over that timeframe and reported nonemergency cases to the U.S. Attorney’s Office, according to a complaint filed in federal court.
A spokeswoman for Northern Light Health, the parent organization of EMMC and Northern Light Medical Transport, said that the service did not intentionally file improper claims and that it had voluntarily initiated the review of its services that prompted the federal investigation.
“During the past 18 months, we have cooperated with the United States Department of Justice as a result of disclosure that we proactively made after determining that some claims we were paid for did not meet the standards of medical necessity required for full payment from Medicare,” spokeswoman Suzanne Spruce said. “We fully cooperated with the Justice Department and repaid any payments that we received in error. In addition, we have increased our internal compliance monitoring to ensure this does not happen again. We regret the error occurred and stress that we never intentionally filed improper claims.”
It’s not the first time in recent memory that a Maine ambulance service was sanctioned for seeking Medicare payment to transport patients who did not medically require the service. In February 2018, North East Mobile Health Services of Scarborough paid $825,000 to resolve allegations that it violated the False Claims Act by providing medically unnecessary ambulance trips away from Maine Medical Center in Portland. At the time, the Portland hospital also paid $600,000 to resolve allegations that its staff had provided incomplete or inaccurate certification for the rides.
The federal investigation of Capital Ambulance found that some of its trips were not medically necessary because the patients had the ability to walk, sit in a wheelchair or chair, or get up from their beds without assistance. The Medicare program is only supposed to cover ambulance rides for patients who are “bed-confined,” according to the U.S. Attorney’s complaint. If patients do not meet that requirement, transportation services are expected to carry them in cars or vans.
In one case on Nov. 16, 2017, Capital Ambulance reportedly carried a 52-year-old about 1.3 miles from EMMC to Stillwater Health Care Center in Bangor, where the patient was going for rehabilitation after an ankle injury. But ambulance records showed that the patient walked before and after the ride and sat on his bed upon arrival.
Two months earlier, the service brought a 63-year-old patient the 2.7 miles from EMMC to Ross Manor nursing home. After they arrived, Capital Ambulance staff reportedly saw the patient sitting in a chair watching a Red Sox game and standing, walking and pivoting with assistance.
In both cases, EMMC staff allegedly certified the ambulance trips because the patients were frail and reportedly felt pain while walking or sitting.