Washington – The U.S. Department of Justice, the Washington State Attorney General’s Medicaid Fraud Control Unit, and the City of Everett Fire Department (EFD) today settled all claims that EFD had been overbilling government programs for medical transports, announced U.S. Attorney Annette L. Hayes. Under the terms of the settlement, Everett will pay the two federal programs $127,848, and will pay the Washington State Medicaid program $75,158.
“When local entities improperly bill federal programs, it increases costs for consumers and taxpayers,” said U.S. Attorney Annette L. Hayes. “This settlement, with Everett paying two times the damages they caused as allowed under federal law, sends a clear message to others who may try to ‘fudge’ the paperwork to get higher reimbursement rates than allowed.”
According to the settlement signed today, between January 1, 2010, and June 26, 2016, Everett Fire Department personnel submitted claims to federal and state health benefit programs indicating that a higher level of life support service was provided to patients covered by those programs. When the Everett Fire Department paramedics provided only basic life support (BLS), they still coded the claims as if they had provided advanced life support (ALS), which is entitled to a higher reimbursement. Analysts used a sample of claims to determine the damages appropriate in this case.
Records indicate that a whistleblower within the Everett Fire Department had expressed concern about the routine up-coding, but was ignored. The fraudulent billing allegations were first publicized by news reports on KIRO-TV. The reports triggered further examination by federal investigators from the Department of Health and Human Services and the Defense Health Agency which administers the TRICARE program for military retirees.
“Insiders willing to report illegal practices are important to safeguarding government health programs and taxpayers,” said Steven J. Ryan, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services. “Together with our federal and state law enforcement partners we will continue to investigate entities that fraudulently bill federal health care programs.”
Everett will pay $117,581 to the Department of Health and Human Services, and $10,267 to the Department of Defense. An additional $75,158 will be paid to Medicaid Fraud Control Unit for the State of Washington.
The press release is available at justice.gov.