A Williston Rescue Squad ambulance is shown during a January 2012 incident.
Williston Rescue Squad Inc. has agreed to pay the United States $800,000.
The payment is to resolve allegations that it violated the False Claims Act by making false claims for payment to Medicare for ambulance transports, the Justice Department announced Monday, Feb. 25, in a press release.
Medicare reimburses providers only for non-emergency ambulance transports if the patient transported is bed-confined or has a medical condition that requires ambulance transportation.
The settlement resolves allegations that WRS billed Medicare for routine, non-emergency ambulance transports that were not medically necessary and that WRS created false documents to make the transports appear to meet the Medicare requirements.
Barnwell County Councilman Lowell Jowers said the settlement should not have any impact on Barnwell County doing business with WRS.
Jowers said the "top three" managment people at WRS when the incidents occurred, from 2008 to 2011, have been replaced.
Barnwell County contracts with WRS for nearly $1 million per year for emergency medical transports throughout the county. The contract is set to renew in June.
"Billing Medicare for unnecessary ambulance transports contributes to the soaring costs of health care," said Stuart F. Delery, Principal Deputy Assistant Attorney General for the Civil Division. "The Department of Justice is committed to pursuing companies that waste limited Medicare funds."
"Medicare fraud is stealing, and it is crippling America's health care system. We have doubled the number of attorneys working these cases in South Carolina. Take notice, if you are bilking the Medicare system designed to support our elders, we are working to find you. For the honest service providers, which is a greater majority of the community, you can report fraud at 1-800-MEDICARE," said William N. Nettles, U.S. Attorney for the District of South Carolina in the release.
"Back in 2011, the government identified various billing concerns at the Williston Rescue Squad, which arose from claims submitted from the WRS Transport division from 2008 to 2011. These claims related primarily to the transport of dialysis patients," current WRS director Phil Clarke said in an emailed statement.
The settlement resolves a lawsuit filed by Sandra McKee under the qui tam, or whistleblower provisions, of the False Claims Act. McKee is a clinical social worker at a facility that regularly received patients transported by WRS ambulances. Under the False Claims Act, private citizens can bring suit on behalf of the United States and share in any recovery. McKee will receive $160,000 as her share of the government's recovery.
"(WRS) fully cooperated with the government, which resulted in a settlement agreement in which there was no admission of liability by (WRS)," said Clarke. "However, to resolve the government's concerns and to bring closure to the process, (WRS) agreed to make certain payments to the government."
This resolution is part of the government's emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009.
"(WRS) is committed, more than ever, to serving the community of Barnwell and has emerged from this incident a stronger and more focused company concentrating on what it has always done best, emergency medical services," Clarke said.
Editor's note: There is no connection between the town of Williston and Williston Rescue Squad except that WRS operates in Williston and throughout Barnwell County. Williston Rescue Squad is a private orangization under contract with Barnwell County.
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