DALLAS (CN) – Dallas agreed on Tuesday to pay the state and federal governments almost $2.47 million to settle allegations that it “upcoded” Medicare and Medicaid claims for ambulances dispatched on 911 calls.
U.S. Attorney James T. Jacks said the city did not admit wrongdoing or liability. But it agreed to enter into certain compliance obligations to resolve allegations that it violated the civil False Claims Act and Texas Medicaid Fraud Prevention Act from 2006 to 2010.
Ambulance services are coded as either basic life support level or advanced life support. Advanced life support transportation (ALS) is reimbursed at a higher rate by both Medicare and Medicaid.
The state and federal governments say the city directed its billing contractor to code every 911-dispatched transport at the higher ALS level, regardless of whether an ALS service was furnished or the patient’s condition necessitated an ALS intervention.
Prosecutors say state and federal authorities initiated the investigation in response to an August 2009 whistleblower suit brought by Douglas Moore, a former employee of Dallas’ auditing department. Moore is eligible to receive up to 30 percent of the recovery under the settlement.