No doubt some of you are aware that for the last couple of years or so, the city of Dallas has been entangled in a federal whistle-blower suit instigated by a former auditor at City Hall. Douglas Moore revealed that he'd discovered the city and Southwest General Services of Dallas billed the feds for "Advanced Life Support (ALS) level ambulance services for all 911 calls, regardless of whether the beneficiary's condition required that level of service," according to the initial complaint filed at the end of '09 and unsealed last summer. It follows, for those who need something to read over lunch.
Long story short: Moore's whistle-blowing could have run the city upwards of $40 million. And as late as yesterday, the case was heading toward trial, following testy depositions that, according to court docs, were taken in mid-April. But late yesterday the parties agreed to a partial dismissal of the suit, based in part on the fact the city has agreed to settle with the feds for $2.47 million -- without acknowledging it did anything wrong. From a release just sent by the U.S. Attorney's Office:
The City of Dallas has agreed to pay the U.S. and Texas $2.47 million and enter into certain compliance obligations to resolve allegations that it violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act, announced U.S. Attorney James T. Jacks of the Northern District of Texas. The U.S. and Texas contend Dallas caused "upcoded" claims to be submitted to Medicare and Medicaid for city-dispatched 911 ambulance transports between 2006 and 2010.Â Dallas fully cooperated with the investigation, and by settling did not admit any wrong-doing or liability.Yesterday's dismissal agreement, which I pulled off PACER, also follows.Doug Moore v DallasPartial Dismissal of Suit
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 Dallas directed its billing contractor to code every 911-dispatched transport 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 believe Dallas caused to be submitted for payment claims falsely representing to Medicare and Medicaid that such ALS services were appropriate and furnished by Dallas 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 an August 2009 whistleblower suit brought by Douglas Moore, a former employee of Dallas' auditing department. Under the False Claims Act and Texas Medicaid Fraud Prevention Act, private individuals may bring actions alleging fraud on behalf of the U.S. and Texas and collect a share of any proceeds recovered by the suit. Mr. Moore can receive up to 30% of the recovery under the settlement.