The federal government recently charged a New York businessman with health care fraud. The entrepreneur ran a non-emergency medical transportation business in the Buffalo area. The business provided services from 2016 through 2020. It was composed of about 15 vehicles and 20 drivers. Services often included transportation to methadone clinics in the area.
According to the United States Attorney’s Office, the man submitted fraudulent claims for payment to Medicaid. The government claims the business made two illegal errors. First, they state it billed for trips it did not perform. Second, the feds claim the business billed individual rides as group rides, which led to the business requesting a greater then warranted reimbursement amount. The feds claim the company billed the government over $34,000 for these allegedly fraudulent services.
If convicted, the accused faces up to 10 years imprisonment and a $250,000 fine.
Business owners in the healthcare marketplace can learn the following from this case:
- Healthcare fraud is a serious crime. The government has continued its crackdown on healthcare fraud and will aggressively pursue allegations of wrongdoing. This can include an investigation and, if the government finds evidence to support the claims, criminal charges. As noted above, criminal charges can come with harsh consequences like a hefty fine and potential imprisonment.
- The feds need evidence to build a defense. Ideally, the business facing these allegations will have records that can help support a defense to the allegations. In a case like this the business would benefit from the presence of a log of passengers with contact information to support the claim that transportation was provided or that there was more than one passenger to warrant a group charge. This could counter the charges and any evidence the government may have gathered during their investigation.
If nothing else, the case serves as a reminder of the importance of good record keeping. Business owners are wise to take the time to run an internal audit and make sure employees are keeping the records needed to support claims to Medicare, Medicaid, and other insurance providers.
