FWA (MA) – MedStar Ambulance pays $2.6 million in false Medicaid billing case

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[MM Curator Summary]: 2nd time in 6 years this same company has settled with the state for Medicaid fraud.






Worcester Telegram & Gazette

LEOMINSTER — The state attorney general’s office announced Tuesday it has reached a $2.6 million settlement with a Leominster-based ambulance company.

MedStar Ambulance Inc., along with its parent corporation and affiliates, settled with the office of Attorney General Andrea Campbell to resolve allegations that the company submitted false claims to MassHealth, the state’s Medicaid program.

MedStar provides services to several Central and Western Massachusetts cities and towns including Worcester, Fitchburg and Leominster.

Campbell’s office contended that the company knowingly submitted false claims to MassHealth for emergency ambulance services when only a less expensive level of service was provided.

Additionally, the office alleged that MedStar did not follow MassHealth regulations because it provided non-emergency ambulance services or wheelchair van services without appropriate medical necessity documentation. Furthermore, the office alleges that MedStar submitted claims to MassHealth for services where they had not actually shown the appropriate medical necessity documentation to the authorized provider who was signing it. 

Campbell’s office also alleges MedStar did not follow regulations because it provided nonemergency ambulance services or wheelchair van services without appropriate medical necessity documentation, and provided MassHealth with claims for services that did not show the appropriate documentation.

In addition to paying back $2.6 million to MassHealth, MedStar has agreed to implement company-wide training and update its policy on compliance with MassHealth medical necessity requirements, according to a release from Campbell’s office.

MedStar has been in hot water for allegations of false billing before.

In 2017, a Sturbridge woman was awarded $3.56 million of a $12.7 million settlement for her role as the whistleblower who alleged that MedStar and its affiliates fraudulently billed Medicare for unqualified services.

The alleged fraud in the 2017 settlement included billing for ambulance trips that were not medically necessary and “up-coding” runs — or making them seem more serious than they actually were — to get higher payments from the government, according to the complaint.


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