When 2022 began, the No Surprises Act came into effect. As we reported when the year began, the new rules and regulations make it so that no one can receive medical bills with unexpected charges on them. Among the new rules presented by the No Surprises Act, surprise bills for most emergency services are banned. They include out-of-network cost-sharing (such as out-of-network coinsurance or copayments) for most emergency and some non-emergency services.
The No Surprises Act would effectively put a stop to such practices as ambulance companies submitting improper claims. As reported by the District of Connecticut branch of the United States Department of Justice, AMR (American Medical Response of Connecticut, Inc.) submitted false claims to Medicare and Medicaid.
AMR has paid $601,759 to resolve allegations.
While the company was not found guilty of the allegations, the DoJ report reveals that AMR paid $601,759 to resolve the government’s allegations. The company was accused of submitting improper claims between January 2014 and December 2019. According to the allegations, AMR would often bill Medicare and Medicaid for Advanced Life Support (ALS) or paramedic services. Meanwhile, it was only providing Basic Life Support (BLS) or ambulance transport services.
The DoJ explains that ALS includes services that are performed by a paramedic at the scene of an emergency response and in the ambulance. They require a high level of medical monitoring. BLS offers lower acuity services. They can be performed by an emergency medical technician-basic. They can also relate to the transport of the patient in the ambulance to a hospital or other medical facility.
ALS is usually offered to Connecticut residents who call 911.
While AMR provides both ALS and BLS services, they are sometimes dispatched to scenes to provide ambulance transport only. This falls under the category of BLS. If both the fire department and AMR are on the scene at the same time, this is considered a “joint response”. The DoJ explains that billing for ALS services is appropriate in “joint response” situations. However, this would require a written billing agreement between AMR and the local fire departments.
During the relevant time period, AMR had no such agreements in place. “For claims submitted to Connecticut Medicaid, in many cases, both AMR and the local fire departments billed Medicaid for ALS/paramedic services,” explains the DoJ report, “As a result, Medicaid actually paid twice for the paramedic services, once to the local fire departments and a second time to AMR.”
AMR has agreed to stop their conduct.
In addition to the settlement, the company has entered into a consent agreement with the Connecticut Department of Public Health. They have vowed to cease and desist the prohibited conduct. As well, they will pay a $25,000 civil penalty to the State of Connecticut.
At Allegiant Experts, we take the issue of improper medical bills seriously. As part of our services, we review medical bills, insurance explanation of benefits and medical records for accuracy. As well, our team assists attorneys by evaluating medical bills and records to support the fair market value for provider payment, expert rebuttal, mediation or expert testimony regarding the value of the services rendered.
For more information, please don’t hesitate to call us at 407-217-5831 or email us at email@example.com.