Houston DA: Medicare ignores evidence of fraud
Between 2005 and 2010, Medicare records show that at least $488 million was paid to non-emergency Harris County ambulance providers
By Terri Landford
The Houston Chronicle
HOUSTON — Harris County prosecutors complained to federal Medicare authorities for at least two years that rampant fraud involving private ambulances across the region was costing taxpayers millions of dollars, but say their concerns were ignored.
"We have been beating our heads against a wall for two years now," Harris County District Attorney Pat Lykos said Monday, a day after the Houston Chronicle reported that Harris County leads the nation in the number of private ambulance companies, vehicles and Medicare payments. "They're totally unresponsive. This is tens of millions of dollars being wasted. This isn't rocket science."
Lykos' office provided the Chronicle Monday with letters and records documenting prosecutors' frustration since 2009.
"We need Centers for Medicare and Medicaid Services to address this staggering and out-of-control problem," Lykos wrote last year to Centers for Medicare and Medicaid Services Acting Director Jonathan Blum, calling Houston "the epicenter for a massive Medicare fraud scheme."
Concerns brushed off
The Chronicle report Sunday documented the ever-escalating quest for Medicare dollars, in which able-boded patients, many mentally ill, are transported by private ambulances, whether they need a costly EMS ride or not.
Between 2005 and 2010, Medicare records show that at least $488 million was paid to non-emergency Harris County ambulance providers. By comparison, the Houston Fire Department received nearly $54 million during that same time period for emergency ambulance transports.
But for two years, Medicare officials have brushed off suggestions made by Lykos, as well as U.S. Reps. Kevin Brady, R-The Woodlands, and Gene Green, D-Houston, that Medicare requires more stringent regulations, specifically something more than a doctor's signature before ambulance costs are reimbursed.
"It really is disturbing," said financial crimes chief Joni Vollman, who brought the issue to Lykos' attention shortly after Lykos took office in 2009.
Brady and Green also sent letters in 2009 to then-acting administrator for Medicare, Charlene Frizzera.
"Federal prosecutors in our districts inform us that fraud is rampant in scheduled, non-emergency, repetitive ambulance transports in the Houston area," the congressmen's letter stated.
They pointed to the agency's reliance on a single doctor's form, known as a physician certification statement. Before Medicare can pay for ambulance transport, patients must get a "PCS" from a doctor declaring the transport is "medically necessary."
If an ambulance company, even a fraudulent one, has the statement, it's difficult for prosecutors to prove in court the trip was unnecessary, even if the patient can walk.
"In order to allow for prosecution of Medicare providers who seek a way to defraud the Medicare program, changes must be made to (the regulation)," the congressmen's letter stated.
'Paying top dollar'
Four months later, Frizzera told Green the agency was "concerned" and would continue to "consider" changes.
Then, Lykos warned Blum: "Without a change in the law, Medicare is paying top dollar for a non-emergency ambulance transport when the person could have safely traveled by wheelchair van, taxi, automobile or any means other than ambulance," she wrote.
On Monday, Medicare spokesman Brian Cook said: "Unfortunately, due to pending law enforcement action, we are unable to comment about a policy change at this time."
U.S. Rep. Pete Olson, R-Sugar Land, told the Chronicle Monday that he found the problems detailed in the newspaper "deeply troubling" and hoped to address some of the issues in Houston in upcoming Medicare fraud legislation.
In 2009, at least $62 million poured into ambulance companies' hands here, according to the Houston Chronicle investigation. By comparison, New York City EMS companies received $7 million.
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