False Claims Act Violations Revealed in Lawsuit Against AmeriCare
The U.S. government recently filed a motion to intervene in a false claims lawsuit brought against AmeriCare Ambulance Service, which provides service to Hillsborough and Polk County Medicare and Medicaid patients. In the suit, the relator (the person who exposed AmeriCare and brought this lawsuit) alleges that AmeriCare billed the government for medically unnecessary ambulance services, which violates the False Claims Act and the Florida False Claims Act.
Under Medicare and Medicaid, non-emergency ambulance service is covered if the beneficiary is “bed-confined,” which is defined as:
- The beneficiary is unable to get up from bed without assistance.
- The beneficiary is unable to ambulate.
- The beneficiary is unable to sit in a chair or wheelchair.
Non-emergency service is also covered if it’s repetitively scheduled and the ambulance provider gets a written order from the beneficiary’s attending physician confirming that the above requirements have been met.
The relator, Ernest Sharpe, who worked as a paramedic for AmeriCare for five months, also alleges that he was fired after he reported the fraud perpetrated by AmeriCare. During his orientation and field training, Sharpe was instructed to document that patients be transferred by slide sheet and soft stretcher, regardless of their ability to walk. This would ensure that the patients could be classified as “bed-confined” and that Medicare would ultimately pay the claims.
After Sharpe’s first 90 days of employment with AmeriCare, he received a written evaluation that deemed him “outstanding” in every work category. However, shortly thereafter, he was asked to rewrite a report to ensure that it was good enough to convince Medicare to reimburse AmeriCare. He rewrote the report in an almost identical fashion and informed his supervisor that he felt as though AmeriCare was committing fraud by altering their reports.
Sharpe’s evaluation was subsequently revised to “average”; he was told that only supervisors could earn an “outstanding” rating. The following month, the same supervisor let Sharpe know that his reports had been shared with other supervisors and that his reports should look just like the supervisors’ reports. At that point, Sharpe stated that he felt as though he was being retaliated against because he had indicated that he thought AmeriCare was committing fraud. After that conversation, Sharpe’s reports were consistently returned to him and deemed deficient.
Three days later, Sharpe reported AmeriCare’s alleged fraudulent activities to the Florida Agency for Health Care Administration, which oversees Florida’s Medicare program. After being written up for taking photos on the job, Sharpe notified two supervisors that he was submitting the photos to the State of Florida as part of the fraud complaint. Four days later Sharpe was terminated for allegedly taking AmeriCare files and sabotaging their computer network.
In January of this year, the United States government initially declined to intervene in the case, however, it continued its investigation and on June 30, 2017, it filed a motion to intervene. The government alleges that AmeriCare submitted thousands of medically unnecessary claims to Medicare for ambulance services and was granted funding that should not have been covered by the insurance program. During the government’s investigation of AmeriCare, they’ve spoken to employees and administrators who have confirmed the company’s scheme.
The case is United States ex rel. Sharpe v. AmeriCare Ambulance Service, No. 8:13-cv-01171 (M.D. Fla. 2013).
Sharpe, who is pursuing a separate lawsuit based on AmeriCare’s decision to terminate him, is represented by Berger & Montague, P.C., and Wenzel Fenton Cabassa, P.A.
Relators and the False Claims Act
Under the False Claims Act (“FCA”), or Lincoln’s Law, it is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. The FCA protects the U.S. government from abuse, fraud, and waste in federal spending. Much of the Act’s success can be tied to lawsuits brought by whistleblowers, or “relators”, who under the qui tam provisions of the Act, can file a lawsuit on the government’s behalf. Many instances of fraud would go undetected if not for private citizen whistleblowers. They’ve become an essential resource responsible for more than half of the $48 billion recovered by the government under the False Claims Act between 1986 and 2015.
If you feel as though you were terminated for reporting an illegal act carried out by your employer, your rights may be protected under federal and state whistleblower laws. If you’ve witnessed illegal, fraudulent, or unethical actions at work, consider contacting an experienced workplace retaliation attorney who can offer expert advice on how to move forward.
At Wenzel Fenton Cabassa, P.A., we’re here to protect your rights and help you take action if you feel as though you’ve been wrongfully terminated or retaliated against for reporting false claims. Contact one of our Employee Law Attorneys today to schedule your free consultation.
Please Note: At the time this article was written, the information contained within it was current based on the prevailing law at the time. Laws and precedents are subject to change, so this information may not be up to date. Always speak with a law firm regarding any legal situation to get the most current information available.