- Published on Tuesday, 07 June 2011 12:19
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City of Dallas to Pay $2.47 Million in Allegations of Medicare/Medicaid Fraud
The City of Dallas has agreed to pay $2.47 million to the U.S. government to resolve allegations that it violated the False Claims Act and the Texas Medicaid Fraud Prevention Act by upcoding its claims submitted to federal healthcare programs.
Dallas officials reportedly instructed their billing vendor, Southwest General Services of Dallas, to bill all calls received by 911 as advanced life support (ALS) rather than the actual care provided. Medicare and Medicaid require EMS providers to bill at the level of service provided, not the potential care that could be provided.
Douglas Moore, an ex Dallas city auditor, uncovered this practice in April, 2009, when he overheard a Dallas Fire-Rescue captain say that every ambulance transport is billed at the advanced life support level. Moore then brought a qui tam (whistle-blower lawsuit) against the city of Dallas.
The city of Dallas elected to pay the government the $2.47 million and enter into certain compliance obligations to resolve this suit and investigation. The city does not admit to any wrong doing or liability in this case.