BOSTON (Legal Newsline) — Massachusetts Attorney General
Maura Healey has announced her office has sued Cataldo Ambulance Service Inc.
(Cataldo) for $600,000 after allegations the company overbilled the state’s
Medicaid program (MassHealth).
From 2005 to November 2015, the state alleges Cataldo
billed MassHealth for emergency advanced life support (ALS) services in
scenarios where patients only needed emergency basic life support (BLS)
MassHealth reimburses ALS service at a much greater rate
than BLS services. According to Healey, 40 percent of Cataldo’s submissions at
the ALS level should actually have been labeled at the less costly BLS level.
Additionally, Cataldo allegedly kept using this false system
even after notification that patient conditions were insufficient to justify
ASA billing. Cataldo also purportedly ignored the concerns of its own
Healey’s office seeks civil penalties, restitution and
MassHealth exists to provide health care to low-income individuals.
This includes people with disabilities, children and senior citizens.
Handling the matter are assistant attorneys general David
Scheffler and Casey Groff and investigators Scott Grannemann and Nan Browne,
all of Healey’s Medicaid Fraud Division, with assistance from assistant attorney general Diane Barry of Healey’s executive bureau. The matter came
to be after the Insurance Fraud Bureau and Federal Bureau of Investigation
submitted a referral.