In the filing in Nashville federal court last week, First Call Ambulance Service Inc. said the $10,764 allegedly overpaid shouldn't have been multiplied because the company already had more than half of the claims overturned during an appeals process.
The company's dispute with the U.S. Department of Health and Human Services comes as the federal government has stepped up efforts to identify and reduce fraud by Medicare providers. That includes use of private contractors such as AdvanceMed to review claims. AdvanceMed's review of a sample of claims that First Call filed during 2005 and 2006 and related medical records found a 50.94 percent error rate, the basis for multiplying of the overpayment.
That error rate should have been reduced to 25 percent or less based on outcomes of the appeals, which should have lowered First Call's bill, it said.
First Call, whose owners include businessman Alan Sielbeck, offers transportation of patients paid for by government programs including Medicare.
The government questioned whether some of the patients it transported required an ambulance. First Call argued Medicare covers non-emergency, scheduled and repetitive ambulance services if the patient's doctor deemed the trip medically needed.
Getahn Ward covers the business of health care and commercial real estate. He can be reached at 615-726-5968 or through e-mail at firstname.lastname@example.org.
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