Medicare Compliance & Reimbursement

Company gets caught altering medical documentation to justify claims.

If patients' medical records don't reflect medical necessity for non-emergency ambulance transportation, fraud suspicions may arise.

A jury convicted New Bern, NC-based ambulance company Convalescent Transports, Inc. and its president Brian Conner of 343 health care fraud counts, U.S. Attorney Frank D. Whitney recently announced.   Conner and his company also face one count of conspiracy to commit health care fraud and two counts of obstructing an investigation.

From 1999 to 2002, the company fraudulently billed for transporting patients to routine dialysis treatments, claiming that the patients were bed-confined, Whitney alleges. But company employees purportedly documented the patients' abilities to walk, sit in a chair or wheelchair, or get up from a bed without assistance. In one case, a patient was able to drive a private vehicle, employees said.

After learning of an impending 1997 audit of the company's billings, Conner allegedly "directed numerous employees to rewrite and falsify ambulance records to eliminate references to any patient's ability to walk or sit," Whitney says.

From 1997 onward, Conner purportedly told employees to omit such information from patients' records because Medicare and Medicaid would otherwise reject the claims for the ambulance transportation.

Conner faces 10 years in prison for each felony fraud count and five years in prison for the conspiracy and obstruction counts.