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Mass. ambulance company to pay $2.6M over false service claims

Mass. Attorney General Andrea Campbell’s office announced a settlement between MedStar Ambulance, Inc. and MassHealth

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By Kiernan Dunlop

LEOMINSTER, Mass. — An ambulance company based in Leominster has agreed to pay back $2.6 million after the Attorney General’s Office contended the company filed claims with MassHealth for a level of service it did not provide.

Attorney General Andrea Campbell’s office announced the settlement with MedStar Ambulance, Inc., its parent corporation Critical Systems, Inc. and its affiliates in a press release Tuesday.

The ambulance company and its affiliates serve Central and Western Massachusetts towns and cities, including Chicopee, Fitchburg, Leominster, Northampton and Worcester.

The office claims that the companies billed MassHealth for emergency ambulance services when they only provided less expensive, nonemergency services.

In addition, MedStar provided nonemergency ambulance services or wheelchair van services without documentation showing it was medically necessary, the AG’s office claims, which MassHealth’s regulations require.

“The MassHealth program only works when providers play by the rules – and my office will continue to hold those who don’t accountable,” Campbell said in a statement. “By doing so, we can and will protect the integrity of MassHealth and ensure its purpose to provide crucial health care support for the most vulnerable remains intact.”

In addition to the payment, the settlement required MedStar to “implement company-wide training and update its policies related to its compliance with MassHealth medical necessity requirements,” according to the AG’s office.

The matter was investigated by AG Campbell’s Medicaid Fraud Division and aided by MassHealth.

This is not the first time MedStar has been forced to settle claims of false billing.

In 2017, MedStar agreed to pay $12.7 million after a former employee, Dale Meehan, reported finding “numerous instances of fraudulent Medicare billing” in a complaint filed in U.S. District Court.

Alleged fraudulent billing, according to the complaint, included: billing for ambulance transportation services when not medically necessary, billing Medicare for ambulance services provided for transportation to doctor’s offices and double-billing patients and the federal health program for the same services.

Meehan received $3,556,000 of the settlement for reporting the information.

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