Back in June, the city sent word that it had agreed to hand over to the feds $2.5 million -- without acknowledging that, ya know, maybe it did violate the civil False Claims Act and Texas Medicaid Fraud Prevention Act by overcharging Medicare and Medicaid for ambulance rides. Could have been worse: There was a chance the city could have owed the government somewhere closer to $40 million. Much cheaper to settle without acknowledging any wrongdoing. That case, of course, stemmed from the whistle-blowing of then-assistant city auditor Doug Moore, who's currently entangled in a retaliation suit against the city over his dismissal.
So happens, according to the U.S. Attorney's Office, Moore's whistling didn't stop at the Dallas city limits:
The Texas cities of Plano, Frisco, Richardson, 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 James 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.And, reminds the release, since the investigations were the results of Moore's whistleblower suit, he "can receive up to 30% of the recovery under the settlement." Which is why the city says it fired Moore in the first place.
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.
