John O'Brien Jan. 14, 2015, 12:50pm



SPRINGFIELD, Ill. (Legal Newsline) – An Illinois company that provides medical transportation services will pay $500,000 to the United States and the State of Illinois as a result of a False Claims Act settlement.




Beginning in 2001, Lake Shore Medicar defrauded Medicaid by submitting false and fraudulent claims for reimbursement while providing medical transportation services to indigent persons eligible to receive assistance through the program, an amended complaint filed in 2011 alleged.








As part of the settlement, Lake Shore Medicar and majority owner-operator Maria Pamatmat are permanently prohibited from participating in the Medical Assistance Program.




The complaint alleges Lake Shore Medicar made duplicate claims for reimbursement, as well as excessive mileage claims.




“The defendants have knowingly presented to (Illinois Healthcare and Family Services) mileage claims for non-emergency transportation services where the passenger was not the first passenger in the vehicle, thereby causing HFS to pay excessive mileage claims,” the complaint says.




For example, in March 2007 the company submitted claims for 12 Medicaid recipients on the same date in the same vehicle at the same time, traveling the same distance, the complaint said.




The claim resulted in mileage payments totaling $76 for a single, six-mile trip, even though Lake Shore Medicar was only authorized to bill for the first passenger, the complaint says.




The excessive mileage claims eventually totaled more than $900,000, the complaint says.




The governments also alleged the company billed for services not provided. In 2009, the plaintiffs claim Lake Shore Medicar submitted a claim for transporting an individual who was known to be hospitalized at the time.




The complaint alleges this behavior occurred 218 times. On another 9,450 occasions, Lake Shore Medicar submitted a claim for a recipient who received no corresponding medically necessary care, the complaint says.




From Legal Newsline: Reach editor John O’Brien at jobrienwv@gmail.com.


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