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Medstar allegedly violated False Claims Act, to pay $12.7 million penalty

By Mark Iandolo | Feb 1, 2017

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BOSTON (Legal Newsline) — The Department of Justice announced Jan. 13 that Medstar Ambulance will pay $12.7 million after allegations of knowingly submitting false claims to Medicare.


“We expect those who participate in the Medicare program to provide services, including ambulance services, based on the medical needs of patients rather than their desire to maximize profits,” said principal deputy assistant attorney general Benjamin C. Mizer, head of the Justice Department’s Civil Division. “The Department of Justice is committed to ensuring that those who abuse the Medicare program will be held accountable for their actions.”


From Jan. 1, 2011, through Oct. 31, 2014, Medstar purportedly submitted false claims to Medicare by constantly billing for non-qualifying services. These services should not have qualified for Medicare, the department alleges, because they either were not medically reasonable and necessary, billed at higher rates than required for a patient’s condition, or billed for higher levels of services than actually provided.


“Our office is committed to finding and eradicating Medicare fraud wherever it occurs,” said U.S. attorney Carmen Ortiz for the District of Massachusetts. “While we recognize that Medicare does and should pay for medically necessary ambulance services, it is our job to ensure that ambulance providers do not take advantage of the system or the patients. This settlement is part of the office’s ongoing effort to eradicate health care fraud and return money to the taxpayers.”

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U.S. Department of Justice