AMR to pay $600K to resolve government billing claims, feds say
Officials at both the federal and state level said AMR often billed Medicare and Medicaid for advanced service when it provided basic service
Edmund H. Mahony
HARTFORD, Conn. — The American Medical Response ambulance service has agreed to pay $600,000 to settle claims by the federal and state governments that it improperly billed the Medicaid and Medicare government insurance programs for services.
The federal and state governments claimed that AMR billed for paramedic services at the scenes of emergency responses when in fact the services were performed by members local fire departments, federal authorities said.
The settlement encompassed various types of service related to ambulance billing.
Advanced Life Support services involve services performed by a paramedic at the scene of an emergency and in the ambulance and they require a high level of medical monitoring. Basic Life Support services involve a lower degree of care that can be provided by an emergency medical technician or that relate to the transport of a patient in the ambulance to a hospital.
In several municipalities, fire departments provide advanced services when a 911 call is dispatched. In such situations, ambulance services such as AMR are dispatched to provide only basic ambulance transport. When fire departments and AMR respond jointly, it is called a “joint response.”
The federal and state governments claimed that AMR often billed Medicare and Medicaid for advanced services when it was only providing the basic service.
Federal officials said it would have been proper for AMR to bill Medicare for advanced services in situations in which it had a written billing agreement with a municipal fire department, something it did not have during the period subject to the settlement. In Medicaid cases, both AMR and municipal fire departments billed for advanced services, causing Medicaid to pay twice for one service, federal officials said.
Messages seeking comment were left with AMR.
The AMR payment covers the period January 2014 through December 2019.
The case was investigated by the Office of Inspector General for the Department of Health and Human Services and the Connecticut Office of the Attorney General William Tong.
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