Rockingham Regional Ambulance Inc. (“Rockingham”) in Nashua, New Hampshire has agreed to pay a considerable sum to resolve an investigation into charges that it fraudulently billed Medicare and Medicaid for medical services. Rockingham provides ambulance transport services to take patients to hospital emergency rooms and other locations throughout New Hampshire. The ambulance company then bills Medicare and Medicaid for its services in accord with both federal and state programs. The U.S. and New Hampshire governments were investigating charges that for three years from 2003 to 2006, Rockingham submitted claims to the Medicare and Medicaid programs for providing emergency advanced life support services in situations where such services were not necessary. Further, during 2003 and 2004, Rockingham submitted Medicare claims for providing emergency basic life support when the company’s ambulance services actually had been used for non-emergency situations. As a result, Rockingham received payments from the Medicare and Medicaid programs to which it was not entitled.
Submitting claims to Medicare and Medicaid for services that differ from the services actually provided can be a basis for liability under state and federal law, including the federal False Claims Act. Under that statute, if it is established that a person has submitted or caused others to submit false or fraudulent claims, the government can recover treble damages and penalties of $5,500 to $11,000 for each false or fraudulent claim filed. Under the qui tam provision of the federal False Claims Act, a private citizen may file a claim for fraud on the government’s behalf and share in any money received.
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