The Union Leader
Copyright 2008 The Union Leader
CONCORD, N.H. — Rockingham Regional Ambulance has agreed to pay $958,000 to resolve allegations it overbilled Medicare and Medicaid.
U.S. Attorney Tom Colantuono and New Hampshire Attorney General Kelly Ayotte announced the settlement in a news release yesterday.
Rockingham provides ambulance services throughout the state. Its parent corporations include Covenant Health Systems Inc., St. Joseph Hospital of Nashua and St. Joseph Hospital Corporate Services Inc.
The company, without admitting any liability, agreed to pay $882,000 to the U.S. government and $76,000 to the state to resolve allegations of overbilling.
The federal portion has been paid and the state portion either has been paid or will be within days, said Assistant U.S. Attorney John Farley.
According to the press release, Rockingham is paying the fine to resolve allegations that between April 1, 2003 and April 30, 2006, it billed the health programs for providing advanced life support services when it was not medically necessary or not documented properly.
The payment also settled allegations that between April 1, 2003 and Dec. 31, 2004, it submitted claims to Medicare using a billing code indicating it provided emergency basic life support when services were provided for non-emergency situations.
Federal and state investigators alleged as a result of those actions, Rockingham received payments from Medicare and Medicaid that it was not entitled to.
Medicaid fraud investigators were first to observe what they believed to be abnormalities in the way the company was billing certain emergency codes, said Farley.
“The number of times Rockingham was billing for that (service) seemed to be higher than other providers,” he said.
Rockingham Regional Ambulance Executive Director Chris Stawasz released a written statement about the settlement yesterday.
“Health-care billing today is an extremely complex process, and we have worked with great effort to strengthen and improve not only our billing process but our documentation systems as well,” Stawasz wrote. “We are absolutely committed to providing the best level of clinical services to our customers as well as maintaining the ethical integrity of our billing process in a manner consistent with all applicable laws.”
Farley said Rockingham fully cooperated in the investigation.
“When we approached the company and identified these allegations, they were very responsible,” he said. “They recognized that there were areas of concern.”
In addition to paying the settlement amount, Rockingham agreed to enter into a separate Corporate Integrity Agreement with the Office of Inspector General of the U.S. Department of Health and Human Services.
Farley said the investigation and its outcome show the system has sufficient safeguards in place.
“It proves that both federal and state fraud investigators are keeping an eye out looking,” he said. “We don’t just wait for whistleblowers to come to us.”