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February 26, 2018

MaineMed, ambulance provider settle civil lawsuits for $1.4M

The U.S. Attorney’s Office for the District of Maine has announced settlements of two civil lawsuits related to unnecessary ambulance transports and improper Medicare billing.

In a Friday press release, U.S. Attorney Halsey B. Frank said that Scarborough-based North East Mobile Health Services has agreed to pay $825,000 to resolve allegations that it violated the federal False Claims Act by providing unnecessary ambulance transports.

The case stems from allegations that North East improperly billed Medicare for the non-emergency transport of patients discharged from Maine Medical Center, of Portland, from 2007 onward.

The government had alleged that North East improperly billed Medicare for ambulance transports of patients it falsely claimed were either “bed-confined” or for whom such transport was otherwise medically necessary.

The settlement also resolves allegations that North East knowingly retained Medicare overpayments.

Resolving a separate civil case, MaineMed agreed to pay $600,000 stemming from allegations that its personnel provided North East with statements containing incomplete or inaccurate information about the medical necessity of moving patients by ambulance, which North East used to bill Medicare.

Both North East Mobile Health and Maine Med cooperated with the investigation, according to the U.S. Attorney’s Office.

It underscored that federal authorities encourage health care providers to cooperate with investigations involving the possible submission of false claims to federal programs.

MaineMed's response

In a written statement sent to Mainebiz, Maine Medical Center issued the following response on Friday regarding the settlement:

"In response to a settlement agreement announcement today by the U.S. Attorney’s Office for the District of Maine, Maine Medical Center issues the following statement:

“Today’s news of Maine Medical Center’s settlement agreement with the U.S. Attorney’s Office is the unfortunate result of a legal process that at times penalizes hospitals for prioritizing safe patient care. As an independent reviewer confirmed, MMC has no financial incentive to order ambulance transfers for Medicare patients treated at its hospital and saw no financial gain as a result of the disputed charges. Each case examined was based on medical necessity determined by a qualified medical provider. However, as the settlement agreement explicitly states, in order to ‘avoid delay, uncertainty, inconvenience, and expense of protracted litigation’ MMC has agreed to a settlement that is modest relative to the potential legal costs, and one that makes clear the hospital’s position that it did nothing wrong. At all times, MMC acted with the best interests of patients in mind, making sure they had safe and reliable transportation following their treatment. We will continue to prioritize safe patient care and ensure that patients who have medical necessity receive access to ambulance services in a way that fully complies with legal and regulatory standards.”

North East Mobile Health Services' response

In a written statement sent to Mainebiz today, North East Mobile Health Services issued the following response:

“At the request of medical personnel, North East Mobile Health Services transported Maine Medical Center patients via ambulance to hospitals, skilled nursing facilities and other locations. In all instances, all providers were acting in the best medical interest of the patient and the required documentation from medical personnel certified the ambulance transports were medically necessary. As such, reimbursement claims were submitted to Medicare and processed.

“However, the medical necessity of some of these ambulance transports was subsequently contested. The Office of the Inspector General and the Department of Justice conducted a review, with the full cooperation of North East Mobile Health Services, and ultimately claimed that the ambulance transports in question were not medically necessary as defined by Medicare.

“Although North East Mobile Health Services continues to deny that all the transports were not medically necessary, North East Mobile Health Services has agreed to repay the claims, the cost of which is less than defending a lawsuit.”

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