DALLAS (CN) – Eleven Texas cities will pay the federal and state governments $1.69 million to resolve False Claims Act and Medicaid fraud claims.
State and federal prosecutors said the cities submitted “upcoded,” or more expensive, claims for city-dispatched ambulances from 2006 to 2010. The cities, which did not admit wrongdoing, are Plano, Frisco, Richardson, Mesquite, Celina, DeSoto, Corpus Christi, Cedar Hill, Rowlett, North Richland Hills and University Park.
“Ambulance services generally are coded either as basic life support level or advanced life support. ALS transports are reimbursed at a higher rate by both Medicare and Medicaid. The U.S. and Texas contend the cities’ billing contractor coded 911-dispatched transports at the ALS level, which indicates an ALS service was furnished and/or the patient’s condition necessitated an ALS intervention,” the U.S. Attorney’s Office in Dallas said in announcing the settlement.
It added that in the cases involved, ALS services were not performed or the patient did not require the ALS transport.
The investigation began after a February 2010 whistleblower suit brought by Douglas Moore, who can receive up to 30 percent of the recovery under the settlement.
In June, Dallas agreed to pay $2.47 million to settle similar upcoding claims.