2 Conn. ambulance firms to pay $600,000 in insurance fraud settlement

They allegedly improperly billed Medicare and Medicaid by charging for "medically unnecessary transportation" for patients going to and from regular dialysis appointments

By Frank Juliano
Connecticut Post

STRATFORD, Conn. — Two local ambulance services under the same ownership and covering nearly all of Fairfield County, have agreed to pay nearly $600,000 to the federal government to resolve allegations that they improperly billed Medicare and Medicaid.

Nelson and Access Ambulance Service charged for "medically unnecessary transportation" for patients going to and from regular dialysis appointments, said Thomas Carson, spokesman for U.S. Attorney Deirdre M. Daly.

The companies provide services to patients at a number of hospitals and nursing homes in the region, including in Danbury, Bridgeport, Stamford and Greenwich.

"The government alleges that the companies, which have the same ownership, regularly transported patients by ambulance, at an average cost of about $380 for each round trip, when the patients did not meet the criteria of being `bed confined' or otherwise have a medical condition requiring transportation by ambulance," the spokesman for the federal prosecutor said Thursday.

Patients transported by Nelson and Access were typically picked up at their residences or at nursing homes and transported by ambulance to and from dialysis treatment three times per week, Carson said.

The regulations indicate that the patient must be "bed confined" or otherwise have a medical condition such that transportation by ambulance is medically required.

Some of the same patients Nelson and Access brought to dialysis in an ambulance were taken to and from other doctor's visits in a wheelchair van, for about $60 for each round trip, Carson said.

In entering into the civil settlement agreement, Nelson and Access did not admit liability but they agreed to pay out $595,000 to resolve the allegations.

The incidents of improper billing allegedly occurred between January 2008 and August 2013, Carson said. The case was investigated by the Office of Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation.

Attorneys for Nelson and Access sent Hearst Connecticut Media the following written statement regarding the investigation: "Nelson and Access Ambulance have fully cooperated with the Office of the U.S. Attorney. Nelson and Access Ambulance transported its patients according to the written instructions of their physicians, which is known in the medical field as a Physician Certificate Statement (`PCS') and also referred to as a Certificate of Medical Necessity (`CMN'). These forms state that in the physician's professional medical opinion, this patient requires transport by ambulance and should not be transported by other means. The patient's condition is such that transportation by medically trained personnel is required. Nelson and Access Ambulance continue to believe that the transportation it provided to its patients at the physician's written direction was the safest method of transportation for its patients."

Carson said in a news release that the ambulance company has offices in Bridgeport and North Haven, but Phil Onofrio, vice president of operations for Nelson and Access, said Thursday that the company no longer has an office in Bridgeport.

"We're moving into a building on Research Drive in Stratford, but there is no signage up yet,'' he said.

Onofrio told Hearst Connecticut Media in an interview two years ago that there had been issues with an aggrieved ex-employee who was forging documents. Onofrio did not name the former employee.

The case is being prosecuted by Assistant U.S. Attorney Richard M. Molot and Auditor Kevin Saunders. People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at 203-777-6311.


©2015 the Connecticut Post (Bridgeport, Conn.)

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