Re: Medicare fraud, OR, Your future with Bubba

[Guest guest]

From what I can tell from the opinion, the street medics cooperated with the

FBI and provided essential evidence against the defendants.

Since whatever actions might be take against them would be outside the

jurisdiction of the federal courts, there's no indication about that.

I fully expect that they were required to do record falsification in order to

keep their jobs--not an excuse under the law, but given the complete

disparity in power between street medics and management, it's understandable.

I would advise any medic who is pressured to do thi to immediately contact

the FBI and become a witness rather than a defendant. And there are also what

are known as qui tam suits that people can file against companies and be

rewarded with a significant percentage of any money recovered by the government

from those companies.

When a company like PTS gets away with its fraudulent acts, it takes money

directly from the pockets of honest operators. Yet, I have no doubt that many

honest operators wink at the actions of their competitors even though they

know what's going on. If I had a company and my competition were stealing

Medicare funds, I'd be in the FBI office the next morning blowing the whistle.

There's a culture in EMS of " everybody does it " that needs to stop. That's

why I hope Wise's sentence is doubled to 60 months with Bubba rather than 30.

This will only stop when folks start going to federal prison.

Also, federal prosecutors should seek to have companies who commit fraud

declared to be a " criminal purpose organization " pursuant to U.S.S.G. section

8C1.1 (the sentencing guidelines). Section 8C1.1 provides that fines for

criminal purpose organizations should divest them of their assets.

Gene G.

>

> I simply can not fathom why anyone, much less a “MEDICAL PROFESSIONALâ€

> would falsify documents.  I wonder how many of them took an ethics course.

>

>

>

> I understand (don’t agree with, but understand their motivation) the greed

> aspect of it on the part of the company, its owners and managers.  However;

> why in the world would street medics falsify their patient care forms?  Gene,

> is there any indication that they had any disciplinary action taken against

> them, either in court, or via their certifications?

>

>

>

>

>

>

>

> Tater

>

> wegandy1938@... wrote:

> For those of you who are thinking about " fixing " your patient care forms to

> make your patients eligible for Medicare reimbursement, or, worse, if you

> are

> doing it now, here's some light reading for you.   This is the actual text

> of a

> Medicare fraud case from Arkansas.

>

> *

> -2-

> _______________

> Nos. 04-1373/1381

> _______________

> United States of America, *

> *

> Appellant/Cross-Appellee, **

> v. **

> Wise, *

> *

> Appellee/Cross-Appellant. *

> ___________

> Submitted: January 10, 2005

> Filed: July 5, 2005

> ___________

> Before LOKEN, Chief Judge, MORRIS SHEPPARD ARNOLD and MURPHY,

> Circuit Judges.

> ___________

> MURPHY, Circuit Judge.

> Patient Transfer Service, Inc. (PTS) and two of its employees were convicted

> by a jury for filing false Medicare and Medicaid claims. The district court

> sentenced

> PTS to a large fine, {$1,177,786} Wise to 30 months and a $6,000 fine,

> and Shirley Wallace

> to 100 hours of community service. PTS appeals its conviction and sentence.

> The

> government appeals the sentences of the employees, and on their cross

> appeals

> they

> appeal their convictions and sentences. We affirm in part and reverse in

> part.

> -3-

> I.

> PTS is an Arkansas company owned by Wise that provides ambulance

> transport services. Wise's brother, Wise, is a licensed

> paramedic who

> worked as the general manager of PTS. In that capacity Wise was in

> charge

> of all personnel and oversaw billing procedures. Shirley Wallace is the

> cousin of

> these two brothers, and she was the office manager and supervised the

> billing

> clerks

> who filed claims with Medicare and Medicaid.

> From January 1997 to March 1999, PTS filed 2,568 Medicare or Medicaid

> claims with identical coding. All of the claims related to the

> transportation

> of twelve

> individuals with end stage renal disorder. PTS transported them by ambulance

> from

> home to a dialysis treatment center and back. In advance of each transport

> Wallace

> prepared a transfer form which stated that the patient was confined to bed

> and could

> only be moved by stretcher to and from the hospital. The transfer form was

> given to

> the paramedics operating the ambulance, who would fill in information

> particular to

> the transport, such as the date, time, and crew names. After the patients

> were

> transported, the transfer forms would be routed to billing clerks to prepare

> claim

> forms for Medicare and Medicaid.

> The claim forms contain billing codes the ambulance provider had to fill out

> to describe the transport: Hospital Admit (yes or no); Type of Transport

> (initial trip,

> return trip, transfer trip, or round trip); Bed Confined - Before (yes or

> no); Bed

> Confined - After (yes or no); Moved by Stretcher (yes or no); Unconscious /

> Shock

> (yes or no); Emergency Situation (yes or no); Physical Restraints (yes or

> no); Visible

> Hemorrhaging (yes or no); Transported To / For (nearest facility, preferred

> physician,

> nearness of family members, or care of a specialist or availability of

> specialized

> equipment); and Medically Necessary (yes or no). In each of the claims at

> issue, the

> billing clerk at PTS marked " Y " for " yes " for the codes Bed Confined -

> Before, Bed

> -4-

> Confined - After, Moved by Stretcher, and Medically Necessary. PTS was

> reimbursed $841,276 on the basis of these 2,568 claims.

> The government investigated PTS and uncovered evidence that these patients

> had not been confined to bed, had not been moved by stretcher, and had not

> needed

> to be transported by ambulance. Medical personnel from the treatment centers

> testified that each of these twelve patients could have been transported to

> and from

> the centers by other means without endangering their health. The FBI

> videotaped

> several of the patients walking to or out of the ambulance and their home or

> treatment

> center without assistance. Paramedics testified that instead of being

> transported by

> stretchers, some of the twelve rode in the front seat of the ambulance or in

> the

> captain's chair (an individual seat behind the driver). One of the patients

> testified that

> statements on the claim forms indicating that she was confined to bed and

> needed a

> stretcher and ambulance transport were false. The husband of another patient

> gave

> similar testimony. There was additional evidence that the patients'

> activities were

> inconsistent with the descriptions on the claim forms. Some of them drove,

> cleaned

> house, gardened, bowled, and engaged in other active pursuits.

> The investigation also yielded evidence that the defendants knew that these

> twelve patients did not fit the descriptions on the claims. Both Wise

> and

> Wallace met a few of the patients in the PTS office, and Wise made some of

> the

> transports himself. Transfer forms were occasionally returned with notes

> from

> the

> paramedics indicating that family or friends picked up the patients from the

> treatment

> center, and some of the paramedics questioned Wise about the necessity

> of

> ambulance transport for patients who walked without assistance. Wise

> distributed a

> memo directing the paramedics to have all dialysis patients ride on

> stretchers and to

> take them into the treatment centers on stretchers. He also told paramedics

> and other

> employees that PTS had letters of medical necessity on file for the dialysis

> patients,

> but an FBI search uncovered no such letters relating to these twelve

> patients. One

> item discovered in the search was a note written by Wallace indicating that

> the

> -5-

> nephrologist treating Phyllis Warren, one of the patients, had advised that

> she did not

> need ambulance transport.

> The government also investigated two instances in which PTS " double hauled "

> by transporting two patients together in one ambulance and billing both

> accounts for

> the mileage. Neither were on stretchers; one patient rode in the front seat,

> and the

> other in the captain's chair. When the billing clerk at PTS noticed the

> coincidence of

> dates and times on the transfer forms, she asked Wallace and Wise how

> to

> prepare the claim forms because she did not believe the mileage could be

> reimbursed

> twice. She was nevertheless instructed to submit individual claims for each

> patient.

> The claim forms did not indicate that more than one patient had been

> transported, and

> each form claimed the full mileage for the trip.

> PTS, Wallace, Wise, and Wise were all charged with and

> acquitted of a conspiracy count that encompassed all 2,568 claims. The jury

> convicted PTS of twenty two counts of aiding and abetting false or

> fraudulent

> claims

> involving Medicare, in violation of 18 U.S.C. §§ 2 and 287, and two counts

> of

> false

> statements involving Medicaid, in violation of 42 U.S.C. § 1320a-7b.

> Wise

> was convicted of four counts of aiding and abetting false or fraudulent

> claims

> involving Medicare in connection with double hauling. Wallace was convicted

> of

> one count of aiding and abetting false or fraudulent claims involving

> Medicare in

> connection with the transport of Phyllis Warren. The court fined PTS

> $1,177,786,

> sentenced Wise to 30 months of imprisonment and a $6,000 fine, and Wallace

> to

> 100

> hours of community service in lieu of a fine.

>

> You can find the remainder of the 21 page opinion by putting in United

> States

> v. Patient Transfer Service, Inc., in Google, if you're interested in

> reading

> about the points on appeal.

>

> Wallace's sentence was upheld.  

>

> The Court remanded the case to the District Court to reconsider the fine

> based upon PTS's contention that it lacks the ability to pay the fine due to

> losses and legal fees resulting from the defense of this case.   There is a

> complex

> system for setting fines, and the Court can either reduce the fine, reimpose

> it, or raise it based upon the further evidence it will hear on that

> subject.

> Be careful what you ask for.

>

> The government won its appeal that Wise's sentence is too lenient, and the

> Court will reconsider.   It is quite likely that his 30 month sentence could

> be

> increased.   The sentencing Court gave him some credit for admitting guilt,

> which the Court of Appeals says the record does not support.   So he may

> well

> find his sentence enhanced.   Either way,   he'll get to meet Bubba.

>

> Gene G.

>

> E.(Gene) Gandy

> POB 1651

> Albany, TX 76430

> wegandy1938@...

>

>

>

>

[Guest guest]

Yes, RICO would be appropriate I think.

I'm watching a situation here in Texas to see what the feds are going to do.

What they do will send a message, and I certainly hope it's the right one.

Gene

> Gene,

>

>

>

> I was thinking of another angle to get more " teeth " into this type of

> fraud.  If there are more than one person involved in committing this fraud,

> prosecutors should look to using the Rico Statute to deem the fraud an

" organized

> crime " .  I hear the penalties are stiffer, besides I have read where people

> have been sentenced under Rico for much lesser crimes that this.

>

>

>

> I agree with having to dissolve assets as part of the punishment to stop

> these companies from moving from one city to the next.

>

> A. Ozenberger BS,LP,CHT

> Training Specialist III

> Education Laboratory

> UTMB - Galveston

> (409)747-2146

> www.utmb.edu/edlab

>

>   _____ 

>

> From: [mailto: ] On

> Behalf Of wegandy1938@...

> Sent: Wednesday, August 03, 2005 2:53 PM

> To: texaslp@...;

> Subject: Re: Medicare fraud, OR, Your future with Bubba

>

>

>

> From what I can tell from the opinion, the street medics cooperated with the

> FBI and provided essential evidence against the defendants.

>

> Since whatever actions might be take against them would be outside the

> jurisdiction of the federal courts, there's no indication about that.

>

> I fully expect that they were required to do record falsification in order

> to

> keep their jobs--not an excuse under the law, but given the complete

> disparity in power between street medics and management, it's

> understandable.  

>

> I would advise any medic who is pressured to do thi to immediately contact

> the FBI and become a witness rather than a defendant.   And there are also

> what

> are known as qui tam suits that people can file against companies and be

> rewarded with a significant percentage of any money recovered by the

> government

> from those companies.

>

> When a company like PTS gets away with its fraudulent acts, it takes money

> directly from the pockets of honest operators.   Yet, I have no doubt that

> many

> honest operators wink at the actions of their competitors even though they

> know what's going on.   If I had a company and my competition were stealing

> Medicare funds, I'd be in the FBI office the next morning blowing the

> whistle.

>

> There's a culture in EMS of " everybody does it " that needs to stop.   That's

> why I hope Wise's sentence is doubled to 60 months with Bubba rather than

> 30. 

> This will only stop when folks start going to federal prison.

>

> Also,   federal prosecutors should seek to have companies who commit fraud

> declared to be a " criminal purpose organization " pursuant to U.S.S.G.

> section

> 8C1.1 (the sentencing guidelines).   Section 8C1.1 provides that fines for

> criminal purpose organizations should divest them of their assets.  

>

> Gene G.

>

>

>

> >

> > I simply can not fathom why anyone, much less a " MEDICAL PROFESSIONAL "

> > would falsify documents.  I wonder how many of them took an ethics course.

> >

> >

> >

> > I understand (don't agree with, but understand their motivation) the greed

> > aspect of it on the part of the company, its owners and managers. 

> However;

> > why in the world would street medics falsify their patient care forms? 

> Gene,

> > is there any indication that they had any disciplinary action taken

> against

> > them, either in court, or via their certifications?

> >

> >

> >

> >

> >

> >

> >

> > Tater

> >

> > wegandy1938@... wrote:

> > For those of you who are thinking about " fixing " your patient care forms

> to

> > make your patients eligible for Medicare reimbursement, or, worse, if you

> > are

> > doing it now, here's some light reading for you.   This is the actual text

> > of a

> > Medicare fraud case from Arkansas.

> >

> > *

> > -2-

> > _______________

> > Nos. 04-1373/1381

> > _______________

> > United States of America, *

> > *

> > Appellant/Cross-Appellee, **

> > v. **

> > Wise, *

> > *

> > Appellee/Cross-Appellant. *

> > ___________

> > Submitted: January 10, 2005

> > Filed: July 5, 2005

> > ___________

> > Before LOKEN, Chief Judge, MORRIS SHEPPARD ARNOLD and MURPHY,

> > Circuit Judges.

> > ___________

> > MURPHY, Circuit Judge.

> > Patient Transfer Service, Inc. (PTS) and two of its employees were

> convicted

> > by a jury for filing false Medicare and Medicaid claims. The district

> court

> > sentenced

> > PTS to a large fine, {$1,177,786} Wise to 30 months and a $6,000

> fine,

> > and Shirley Wallace

> > to 100 hours of community service. PTS appeals its conviction and

> sentence.

> > The

> > government appeals the sentences of the employees, and on their cross

> > appeals

> > they

> > appeal their convictions and sentences. We affirm in part and reverse in

> > part.

> > -3-

> > I.

> > PTS is an Arkansas company owned by Wise that provides ambulance

> > transport services. Wise's brother, Wise, is a licensed

> > paramedic who

> > worked as the general manager of PTS. In that capacity Wise was in

> > charge

> > of all personnel and oversaw billing procedures. Shirley Wallace is the

> > cousin of

> > these two brothers, and she was the office manager and supervised the

> > billing

> > clerks

> > who filed claims with Medicare and Medicaid.

> > From January 1997 to March 1999, PTS filed 2,568 Medicare or Medicaid

> > claims with identical coding. All of the claims related to the

> > transportation

> > of twelve

> > individuals with end stage renal disorder. PTS transported them by

> ambulance

> > from

> > home to a dialysis treatment center and back. In advance of each transport

> > Wallace

> > prepared a transfer form which stated that the patient was confined to bed

> > and could

> > only be moved by stretcher to and from the hospital. The transfer form was

> > given to

> > the paramedics operating the ambulance, who would fill in information

> > particular to

> > the transport, such as the date, time, and crew names. After the patients

> > were

> > transported, the transfer forms would be routed to billing clerks to

> prepare

> > claim

> > forms for Medicare and Medicaid.

> > The claim forms contain billing codes the ambulance provider had to fill

> out

> > to describe the transport: Hospital Admit (yes or no); Type of Transport

> > (initial trip,

> > return trip, transfer trip, or round trip); Bed Confined - Before (yes or

> > no); Bed

> > Confined - After (yes or no); Moved by Stretcher (yes or no); Unconscious

> /

> > Shock

> > (yes or no); Emergency Situation (yes or no); Physical Restraints (yes or

> > no); Visible

> > Hemorrhaging (yes or no); Transported To / For (nearest facility,

> preferred

> > physician,

> > nearness of family members, or care of a specialist or availability of

> > specialized

> > equipment); and Medically Necessary (yes or no). In each of the claims at

> > issue, the

> > billing clerk at PTS marked " Y " for " yes " for the codes Bed Confined -

> > Before, Bed

> > -4-

> > Confined - After, Moved by Stretcher, and Medically Necessary. PTS was

> > reimbursed $841,276 on the basis of these 2,568 claims.

> > The government investigated PTS and uncovered evidence that these patients

> > had not been confined to bed, had not been moved by stretcher, and had not

> > needed

> > to be transported by ambulance. Medical personnel from the treatment

> centers

> > testified that each of these twelve patients could have been transported

> to

> > and from

> > the centers by other means without endangering their health. The FBI

> > videotaped

> > several of the patients walking to or out of the ambulance and their home

> or

> > treatment

> > center without assistance. Paramedics testified that instead of being

> > transported by

> > stretchers, some of the twelve rode in the front seat of the ambulance or

> in

> > the

> > captain's chair (an individual seat behind the driver). One of the

> patients

> > testified that

> > statements on the claim forms indicating that she was confined to bed and

> > needed a

> > stretcher and ambulance transport were false. The husband of another

> patient

> > gave

> > similar testimony. There was additional evidence that the patients'

> > activities were

> > inconsistent with the descriptions on the claim forms. Some of them drove,

> > cleaned

> > house, gardened, bowled, and engaged in other active pursuits.

> > The investigation also yielded evidence that the defendants knew that

> these

> > twelve patients did not fit the descriptions on the claims. Both

> Wise

> > and

> > Wallace met a few of the patients in the PTS office, and Wise made some of

> > the

> > transports himself. Transfer forms were occasionally returned with notes

> > from

> > the

> > paramedics indicating that family or friends picked up the patients from

> the

> > treatment

> > center, and some of the paramedics questioned Wise about the

> necessity

> > of

> > ambulance transport for patients who walked without assistance. Wise

> > distributed a

> > memo directing the paramedics to have all dialysis patients ride on

> > stretchers and to

> > take them into the treatment centers on stretchers. He also told

> paramedics

> > and other

> > employees that PTS had letters of medical necessity on file for the

> dialysis

> > patients,

> > but an FBI search uncovered no such letters relating to these twelve

> > patients. One

> > item discovered in the search was a note written by Wallace indicating

> that

> > the

> > -5-

> > nephrologist treating Phyllis Warren, one of the patients, had advised

> that

> > she did not

> > need ambulance transport.

> > The government also investigated two instances in which PTS " double

> hauled "

> > by transporting two patients together in one ambulance and billing both

> > accounts for

> > the mileage. Neither were on stretchers; one patient rode in the front

> seat,

> > and the

> > other in the captain's chair. When the billing clerk at PTS noticed the

> > coincidence of

> > dates and times on the transfer forms, she asked Wallace and Wise

> how

> > to

> > prepare the claim forms because she did not believe the mileage could be

> > reimbursed

> > twice. She was nevertheless instructed to submit individual claims for

> each

> > patient.

> > The claim forms did not indicate that more than one patient had been

> > transported, and

> > each form claimed the full mileage for the trip.

> > PTS, Wallace, Wise, and Wise were all charged with and

> > acquitted of a conspiracy count that encompassed all 2,568 claims. The

> jury

> > convicted PTS of twenty two counts of aiding and abetting false or

> > fraudulent

> > claims

> > involving Medicare, in violation of 18 U.S.C. §§ 2 and 287, and two counts

> > of

> > false

> > statements involving Medicaid, in violation of 42 U.S.C. § 1320a-7b.

> > Wise

> > was convicted of four counts of aiding and abetting false or fraudulent

> > claims

> > involving Medicare in connection with double hauling. Wallace was

> convicted

> > of

> > one count of aiding and abetting false or fraudulent claims involving

> > Medicare in

> > connection with the transport of Phyllis Warren. The court fined PTS

> > $1,177,786,

> > sentenced Wise to 30 months of imprisonment and a $6,000 fine, and Wallace

> > to

> > 100

> > hours of community service in lieu of a fine.

> >

> > You can find the remainder of the 21 page opinion by putting in United

> > States

> > v. Patient Transfer Service, Inc., in Google, if you're interested in

> > reading

> > about the points on appeal.

> >

> > Wallace's sentence was upheld. 

> >

> > The Court remanded the case to the District Court to reconsider the fine

> > based upon PTS's contention that it lacks the ability to pay the fine due

> to

> > losses and legal fees resulting from the defense of this case.   There is

> a

> > complex

> > system for setting fines, and the Court can either reduce the fine,

> reimpose

> > it, or raise it based upon the further evidence it will hear on that

> > subject.

> > Be careful what you ask for.

> >

> > The government won its appeal that Wise's sentence is too lenient, and the

> > Court will reconsider.   It is quite likely that his 30 month sentence

> could

> > be

> > increased.   The sentencing Court gave him some credit for admitting

> guilt,

> > which the Court of Appeals says the record does not support.   So he may

> > well

> > find his sentence enhanced.   Either way,   he'll get to meet Bubba.

> >

> > Gene G.

> >

> > E.(Gene) Gandy

> > POB 1651

> > Albany, TX 76430

> > wegandy1938@...

> >

> >

> >

> >

[Guest guest]

I simply can not fathom why anyone, much less a “MEDICAL PROFESSIONAL” would

falsify documents. I wonder how many of them took an ethics course.

I understand (don’t agree with, but understand their motivation) the greed

aspect of it on the part of the company, its owners and managers. However; why

in the world would street medics falsify their patient care forms? Gene, is

there any indication that they had any disciplinary action taken against them,

either in court, or via their certifications?

Tater

wegandy1938@... wrote:

For those of you who are thinking about " fixing " your patient care forms to

make your patients eligible for Medicare reimbursement, or, worse, if you are

doing it now, here's some light reading for you. This is the actual text of a

Medicare fraud case from Arkansas.

*

-2-

_______________

Nos. 04-1373/1381

_______________

United States of America, *

*

Appellant/Cross-Appellee, **

v. **

Wise, *

*

Appellee/Cross-Appellant. *

___________

Submitted: January 10, 2005

Filed: July 5, 2005

___________

Before LOKEN, Chief Judge, MORRIS SHEPPARD ARNOLD and MURPHY,

Circuit Judges.

___________

MURPHY, Circuit Judge.

Patient Transfer Service, Inc. (PTS) and two of its employees were convicted

by a jury for filing false Medicare and Medicaid claims. The district court

sentenced

PTS to a large fine, {$1,177,786} Wise to 30 months and a $6,000 fine,

and Shirley Wallace

to 100 hours of community service. PTS appeals its conviction and sentence.

The

government appeals the sentences of the employees, and on their cross appeals

they

appeal their convictions and sentences. We affirm in part and reverse in

part.

-3-

I.

PTS is an Arkansas company owned by Wise that provides ambulance

transport services. Wise's brother, Wise, is a licensed

paramedic who

worked as the general manager of PTS. In that capacity Wise was in

charge

of all personnel and oversaw billing procedures. Shirley Wallace is the

cousin of

these two brothers, and she was the office manager and supervised the billing

clerks

who filed claims with Medicare and Medicaid.

From January 1997 to March 1999, PTS filed 2,568 Medicare or Medicaid

claims with identical coding. All of the claims related to the transportation

of twelve

individuals with end stage renal disorder. PTS transported them by ambulance

from

home to a dialysis treatment center and back. In advance of each transport

Wallace

prepared a transfer form which stated that the patient was confined to bed

and could

only be moved by stretcher to and from the hospital. The transfer form was

given to

the paramedics operating the ambulance, who would fill in information

particular to

the transport, such as the date, time, and crew names. After the patients

were

transported, the transfer forms would be routed to billing clerks to prepare

claim

forms for Medicare and Medicaid.

The claim forms contain billing codes the ambulance provider had to fill out

to describe the transport: Hospital Admit (yes or no); Type of Transport

(initial trip,

return trip, transfer trip, or round trip); Bed Confined - Before (yes or

no); Bed

Confined - After (yes or no); Moved by Stretcher (yes or no); Unconscious /

Shock

(yes or no); Emergency Situation (yes or no); Physical Restraints (yes or

no); Visible

Hemorrhaging (yes or no); Transported To / For (nearest facility, preferred

physician,

nearness of family members, or care of a specialist or availability of

specialized

equipment); and Medically Necessary (yes or no). In each of the claims at

issue, the

billing clerk at PTS marked " Y " for " yes " for the codes Bed Confined -

Before, Bed

-4-

Confined - After, Moved by Stretcher, and Medically Necessary. PTS was

reimbursed $841,276 on the basis of these 2,568 claims.

The government investigated PTS and uncovered evidence that these patients

had not been confined to bed, had not been moved by stretcher, and had not

needed

to be transported by ambulance. Medical personnel from the treatment centers

testified that each of these twelve patients could have been transported to

and from

the centers by other means without endangering their health. The FBI

videotaped

several of the patients walking to or out of the ambulance and their home or

treatment

center without assistance. Paramedics testified that instead of being

transported by

stretchers, some of the twelve rode in the front seat of the ambulance or in

the

captain's chair (an individual seat behind the driver). One of the patients

testified that

statements on the claim forms indicating that she was confined to bed and

needed a

stretcher and ambulance transport were false. The husband of another patient

gave

similar testimony. There was additional evidence that the patients'

activities were

inconsistent with the descriptions on the claim forms. Some of them drove,

cleaned

house, gardened, bowled, and engaged in other active pursuits.

The investigation also yielded evidence that the defendants knew that these

twelve patients did not fit the descriptions on the claims. Both Wise

and

Wallace met a few of the patients in the PTS office, and Wise made some of

the

transports himself. Transfer forms were occasionally returned with notes from

the

paramedics indicating that family or friends picked up the patients from the

treatment

center, and some of the paramedics questioned Wise about the necessity

of

ambulance transport for patients who walked without assistance. Wise

distributed a

memo directing the paramedics to have all dialysis patients ride on

stretchers and to

take them into the treatment centers on stretchers. He also told paramedics

and other

employees that PTS had letters of medical necessity on file for the dialysis

patients,

but an FBI search uncovered no such letters relating to these twelve

patients. One

item discovered in the search was a note written by Wallace indicating that

the

-5-

nephrologist treating Phyllis Warren, one of the patients, had advised that

she did not

need ambulance transport.

The government also investigated two instances in which PTS " double hauled "

by transporting two patients together in one ambulance and billing both

accounts for

the mileage. Neither were on stretchers; one patient rode in the front seat,

and the

other in the captain's chair. When the billing clerk at PTS noticed the

coincidence of

dates and times on the transfer forms, she asked Wallace and Wise how

to

prepare the claim forms because she did not believe the mileage could be

reimbursed

twice. She was nevertheless instructed to submit individual claims for each

patient.

The claim forms did not indicate that more than one patient had been

transported, and

each form claimed the full mileage for the trip.

PTS, Wallace, Wise, and Wise were all charged with and

acquitted of a conspiracy count that encompassed all 2,568 claims. The jury

convicted PTS of twenty two counts of aiding and abetting false or fraudulent

claims

involving Medicare, in violation of 18 U.S.C. §§ 2 and 287, and two counts of

false

statements involving Medicaid, in violation of 42 U.S.C. § 1320a-7b.

Wise

was convicted of four counts of aiding and abetting false or fraudulent

claims

involving Medicare in connection with double hauling. Wallace was convicted

of

one count of aiding and abetting false or fraudulent claims involving

Medicare in

connection with the transport of Phyllis Warren. The court fined PTS

$1,177,786,

sentenced Wise to 30 months of imprisonment and a $6,000 fine, and Wallace to

100

hours of community service in lieu of a fine.

You can find the remainder of the 21 page opinion by putting in United States

v. Patient Transfer Service, Inc., in Google, if you're interested in reading

about the points on appeal.

Wallace's sentence was upheld.

The Court remanded the case to the District Court to reconsider the fine

based upon PTS's contention that it lacks the ability to pay the fine due to

losses and legal fees resulting from the defense of this case. There is a

complex

system for setting fines, and the Court can either reduce the fine, reimpose

it, or raise it based upon the further evidence it will hear on that subject.

Be careful what you ask for.

The government won its appeal that Wise's sentence is too lenient, and the

Court will reconsider. It is quite likely that his 30 month sentence could be

increased. The sentencing Court gave him some credit for admitting guilt,

which the Court of Appeals says the record does not support. So he may well

find his sentence enhanced. Either way, he'll get to meet Bubba.

Gene G.

E.(Gene) Gandy

POB 1651

Albany, TX 76430

wegandy1938@...

[Guest guest]

PTS to a large fine, {$1,177,786} Wise to 30 months and a

$6,000 fine, and Shirley Wallaceto 100 hours of community service.

In my eyes that is a slap in the hand. There was a service in the RGV

that ,rumor has it,that FBI hit them for fraud, a month later they

change the name to something similar, and they are off running the

streets again.

With a slap in the hand like 100 hr of community service, people are

not going to be afraid of taking a risk, there needs to be more

punishment!

> > For those of you who are thinking about " fixing " your patient

care forms to

> > make your patients eligible for Medicare reimbursement, or,

worse, if you

> > are

> > doing it now, here's some light reading for you.   This is

the

actual text

> > of a

> > Medicare fraud case from Arkansas.

> >

> > *

> > -2-

> > _______________

> > Nos. 04-1373/1381

> > _______________

> > United States of America, *

> > *

> > Appellant/Cross-Appellee, **

> > v. **

> > Wise, *

> > *

> > Appellee/Cross-Appellant. *

> > ___________

> > Submitted: January 10, 2005

> > Filed: July 5, 2005

> > ___________

> > Before LOKEN, Chief Judge, MORRIS SHEPPARD ARNOLD and MURPHY,

> > Circuit Judges.

> > ___________

> > MURPHY, Circuit Judge.

> > Patient Transfer Service, Inc. (PTS) and two of its employees

were convicted

> > by a jury for filing false Medicare and Medicaid claims. The

district court

> > sentenced

> > PTS to a large fine, {$1,177,786} Wise to 30 months and a

$6,000 fine,

> > and Shirley Wallace

> > to 100 hours of community service. PTS appeals its conviction and

sentence.

> > The

> > government appeals the sentences of the employees, and on their

cross

> > appeals

> > they

> > appeal their convictions and sentences. We affirm in part and

reverse in

> > part.

> > -3-

> > I.

> > PTS is an Arkansas company owned by Wise that provides

ambulance

> > transport services. Wise's brother, Wise, is a

licensed

> > paramedic who

> > worked as the general manager of PTS. In that capacity Wise

was in

> > charge

> > of all personnel and oversaw billing procedures. Shirley Wallace

is the

> > cousin of

> > these two brothers, and she was the office manager and supervised

the

> > billing

> > clerks

> > who filed claims with Medicare and Medicaid.

> > From January 1997 to March 1999, PTS filed 2,568 Medicare or

Medicaid

> > claims with identical coding. All of the claims related to the

> > transportation

> > of twelve

> > individuals with end stage renal disorder. PTS transported them

by ambulance

> > from

> > home to a dialysis treatment center and back. In advance of each

transport

> > Wallace

> > prepared a transfer form which stated that the patient was

confined to bed

> > and could

> > only be moved by stretcher to and from the hospital. The transfer

form was

> > given to

> > the paramedics operating the ambulance, who would fill in

information

> > particular to

> > the transport, such as the date, time, and crew names. After the

patients

> > were

> > transported, the transfer forms would be routed to billing clerks

to prepare

> > claim

> > forms for Medicare and Medicaid.

> > The claim forms contain billing codes the ambulance provider had

to fill out

> > to describe the transport: Hospital Admit (yes or no); Type of

Transport

> > (initial trip,

> > return trip, transfer trip, or round trip); Bed Confined - Before

(yes or

> > no); Bed

> > Confined - After (yes or no); Moved by Stretcher (yes or no);

Unconscious /

> > Shock

> > (yes or no); Emergency Situation (yes or no); Physical Restraints

(yes or

> > no); Visible

> > Hemorrhaging (yes or no); Transported To / For (nearest facility,

preferred

> > physician,

> > nearness of family members, or care of a specialist or

availability of

> > specialized

> > equipment); and Medically Necessary (yes or no). In each of the

claims at

> > issue, the

> > billing clerk at PTS marked " Y " for " yes " for the codes Bed

Confined -

> > Before, Bed

> > -4-

> > Confined - After, Moved by Stretcher, and Medically Necessary.

PTS was

> > reimbursed $841,276 on the basis of these 2,568 claims.

> > The government investigated PTS and uncovered evidence that these

patients

> > had not been confined to bed, had not been moved by stretcher,

and had not

> > needed

> > to be transported by ambulance. Medical personnel from the

treatment centers

> > testified that each of these twelve patients could have been

transported to

> > and from

> > the centers by other means without endangering their health. The

FBI

> > videotaped

> > several of the patients walking to or out of the ambulance and

their home or

> > treatment

> > center without assistance. Paramedics testified that instead of

being

> > transported by

> > stretchers, some of the twelve rode in the front seat of the

ambulance or in

> > the

> > captain's chair (an individual seat behind the driver). One of

the patients

> > testified that

> > statements on the claim forms indicating that she was confined to

bed and

> > needed a

> > stretcher and ambulance transport were false. The husband of

another patient

> > gave

> > similar testimony. There was additional evidence that the

patients'

> > activities were

> > inconsistent with the descriptions on the claim forms. Some of

them drove,

> > cleaned

> > house, gardened, bowled, and engaged in other active pursuits.

> > The investigation also yielded evidence that the defendants knew

that these

> > twelve patients did not fit the descriptions on the claims. Both

Wise

> > and

> > Wallace met a few of the patients in the PTS office, and Wise

made some of

> > the

> > transports himself. Transfer forms were occasionally returned

with notes

> > from

> > the

> > paramedics indicating that family or friends picked up the

patients from the

> > treatment

> > center, and some of the paramedics questioned Wise about

the necessity

> > of

> > ambulance transport for patients who walked without assistance.

Wise

> > distributed a

> > memo directing the paramedics to have all dialysis patients ride

on

> > stretchers and to

> > take them into the treatment centers on stretchers. He also told

paramedics

> > and other

> > employees that PTS had letters of medical necessity on file for

the dialysis

> > patients,

> > but an FBI search uncovered no such letters relating to these

twelve

> > patients. One

> > item discovered in the search was a note written by Wallace

indicating that

> > the

> > -5-

> > nephrologist treating Phyllis Warren, one of the patients, had

advised that

> > she did not

> > need ambulance transport.

> > The government also investigated two instances in which

PTS " double hauled "

> > by transporting two patients together in one ambulance and

billing both

> > accounts for

> > the mileage. Neither were on stretchers; one patient rode in the

front seat,

> > and the

> > other in the captain's chair. When the billing clerk at PTS

noticed the

> > coincidence of

> > dates and times on the transfer forms, she asked Wallace and

Wise how

> > to

> > prepare the claim forms because she did not believe the mileage

could be

> > reimbursed

> > twice. She was nevertheless instructed to submit individual

claims for each

> > patient.

> > The claim forms did not indicate that more than one patient had

been

> > transported, and

> > each form claimed the full mileage for the trip.

> > PTS, Wallace, Wise, and Wise were all charged with

and

> > acquitted of a conspiracy count that encompassed all 2,568

claims. The jury

> > convicted PTS of twenty two counts of aiding and abetting false

or

> > fraudulent

> > claims

> > involving Medicare, in violation of 18 U.S.C. §§ 2 and 287,

and

two counts

> > of

> > false

> > statements involving Medicaid, in violation of 42 U.S.C. §

1320a-

7b.

> > Wise

> > was convicted of four counts of aiding and abetting false or

fraudulent

> > claims

> > involving Medicare in connection with double hauling. Wallace was

convicted

> > of

> > one count of aiding and abetting false or fraudulent claims

involving

> > Medicare in

> > connection with the transport of Phyllis Warren. The court fined

PTS

> > $1,177,786,

> > sentenced Wise to 30 months of imprisonment and a $6,000 fine,

and Wallace

> > to

> > 100

> > hours of community service in lieu of a fine.

> >

> > You can find the remainder of the 21 page opinion by putting in

United

> > States

> > v. Patient Transfer Service, Inc., in Google, if you're

interested in

> > reading

> > about the points on appeal.

> >

> > Wallace's sentence was upheld.  

> >

> > The Court remanded the case to the District Court to reconsider

the fine

> > based upon PTS's contention that it lacks the ability to pay the

fine due to

> > losses and legal fees resulting from the defense of this

case.   There is a

> > complex

> > system for setting fines, and the Court can either reduce the

fine, reimpose

> > it, or raise it based upon the further evidence it will hear on

that

> > subject.

> > Be careful what you ask for.

> >

> > The government won its appeal that Wise's sentence is too

lenient, and the

> > Court will reconsider.   It is quite likely that his 30

month

sentence could

> > be

> > increased.   The sentencing Court gave him some credit for

admitting guilt,

> > which the Court of Appeals says the record does not

support.  

So he may

> > well

> > find his sentence enhanced.   Either way,   he'll get

to meet

Bubba.

> >

> > Gene G.

> >

> > E.(Gene) Gandy

> > POB 1651

> > Albany, TX 76430

> > wegandy1938@a...

> >

> >

> >

> >

[Guest guest]

Gene,

I was thinking of another angle to get more " teeth " into this type of fraud. If

there are more than one person involved in committing this fraud, prosecutors

should look to using the Rico Statute to deem the fraud an " organized crime " . I

hear the penalties are stiffer, besides I have read where people have been

sentenced under Rico for much lesser crimes that this.

I agree with having to dissolve assets as part of the punishment to stop these

companies from moving from one city to the next.

A. Ozenberger BS,LP,CHT

Training Specialist III

Education Laboratory

UTMB - Galveston

(409)747-2146

www.utmb.edu/edlab

_____

From: [mailto: ] On Behalf

Of wegandy1938@...

Sent: Wednesday, August 03, 2005 2:53 PM

To: texaslp@...;

Subject: Re: Medicare fraud, OR, Your future with Bubba

From what I can tell from the opinion, the street medics cooperated with the

FBI and provided essential evidence against the defendants.

Since whatever actions might be take against them would be outside the

jurisdiction of the federal courts, there's no indication about that.

I fully expect that they were required to do record falsification in order to

keep their jobs--not an excuse under the law, but given the complete

disparity in power between street medics and management, it's understandable.

I would advise any medic who is pressured to do thi to immediately contact

the FBI and become a witness rather than a defendant. And there are also what

are known as qui tam suits that people can file against companies and be

rewarded with a significant percentage of any money recovered by the government

from those companies.

When a company like PTS gets away with its fraudulent acts, it takes money

directly from the pockets of honest operators. Yet, I have no doubt that many

honest operators wink at the actions of their competitors even though they

know what's going on. If I had a company and my competition were stealing

Medicare funds, I'd be in the FBI office the next morning blowing the whistle.

There's a culture in EMS of " everybody does it " that needs to stop. That's

why I hope Wise's sentence is doubled to 60 months with Bubba rather than 30.

This will only stop when folks start going to federal prison.

Also, federal prosecutors should seek to have companies who commit fraud

declared to be a " criminal purpose organization " pursuant to U.S.S.G. section

8C1.1 (the sentencing guidelines). Section 8C1.1 provides that fines for

criminal purpose organizations should divest them of their assets.

Gene G.

>

> I simply can not fathom why anyone, much less a " MEDICAL PROFESSIONAL "

> would falsify documents. I wonder how many of them took an ethics course.

>

>

>

> I understand (don't agree with, but understand their motivation) the greed

> aspect of it on the part of the company, its owners and managers. However;

> why in the world would street medics falsify their patient care forms? Gene,

> is there any indication that they had any disciplinary action taken against

> them, either in court, or via their certifications?

>

>

>

>

>

>

>

> Tater

>

> wegandy1938@... wrote:

> For those of you who are thinking about " fixing " your patient care forms to

> make your patients eligible for Medicare reimbursement, or, worse, if you

> are

> doing it now, here's some light reading for you. This is the actual text

> of a

> Medicare fraud case from Arkansas.

>

> *

> -2-

> _______________

> Nos. 04-1373/1381

> _______________

> United States of America, *

> *

> Appellant/Cross-Appellee, **

> v. **

> Wise, *

> *

> Appellee/Cross-Appellant. *

> ___________

> Submitted: January 10, 2005

> Filed: July 5, 2005

> ___________

> Before LOKEN, Chief Judge, MORRIS SHEPPARD ARNOLD and MURPHY,

> Circuit Judges.

> ___________

> MURPHY, Circuit Judge.

> Patient Transfer Service, Inc. (PTS) and two of its employees were convicted

> by a jury for filing false Medicare and Medicaid claims. The district court

> sentenced

> PTS to a large fine, {$1,177,786} Wise to 30 months and a $6,000 fine,

> and Shirley Wallace

> to 100 hours of community service. PTS appeals its conviction and sentence.

> The

> government appeals the sentences of the employees, and on their cross

> appeals

> they

> appeal their convictions and sentences. We affirm in part and reverse in

> part.

> -3-

> I.

> PTS is an Arkansas company owned by Wise that provides ambulance

> transport services. Wise's brother, Wise, is a licensed

> paramedic who

> worked as the general manager of PTS. In that capacity Wise was in

> charge

> of all personnel and oversaw billing procedures. Shirley Wallace is the

> cousin of

> these two brothers, and she was the office manager and supervised the

> billing

> clerks

> who filed claims with Medicare and Medicaid.

> From January 1997 to March 1999, PTS filed 2,568 Medicare or Medicaid

> claims with identical coding. All of the claims related to the

> transportation

> of twelve

> individuals with end stage renal disorder. PTS transported them by ambulance

> from

> home to a dialysis treatment center and back. In advance of each transport

> Wallace

> prepared a transfer form which stated that the patient was confined to bed

> and could

> only be moved by stretcher to and from the hospital. The transfer form was

> given to

> the paramedics operating the ambulance, who would fill in information

> particular to

> the transport, such as the date, time, and crew names. After the patients

> were

> transported, the transfer forms would be routed to billing clerks to prepare

> claim

> forms for Medicare and Medicaid.

> The claim forms contain billing codes the ambulance provider had to fill out

> to describe the transport: Hospital Admit (yes or no); Type of Transport

> (initial trip,

> return trip, transfer trip, or round trip); Bed Confined - Before (yes or

> no); Bed

> Confined - After (yes or no); Moved by Stretcher (yes or no); Unconscious /

> Shock

> (yes or no); Emergency Situation (yes or no); Physical Restraints (yes or

> no); Visible

> Hemorrhaging (yes or no); Transported To / For (nearest facility, preferred

> physician,

> nearness of family members, or care of a specialist or availability of

> specialized

> equipment); and Medically Necessary (yes or no). In each of the claims at

> issue, the

> billing clerk at PTS marked " Y " for " yes " for the codes Bed Confined -

> Before, Bed

> -4-

> Confined - After, Moved by Stretcher, and Medically Necessary. PTS was

> reimbursed $841,276 on the basis of these 2,568 claims.

> The government investigated PTS and uncovered evidence that these patients

> had not been confined to bed, had not been moved by stretcher, and had not

> needed

> to be transported by ambulance. Medical personnel from the treatment centers

> testified that each of these twelve patients could have been transported to

> and from

> the centers by other means without endangering their health. The FBI

> videotaped

> several of the patients walking to or out of the ambulance and their home or

> treatment

> center without assistance. Paramedics testified that instead of being

> transported by

> stretchers, some of the twelve rode in the front seat of the ambulance or in

> the

> captain's chair (an individual seat behind the driver). One of the patients

> testified that

> statements on the claim forms indicating that she was confined to bed and

> needed a

> stretcher and ambulance transport were false. The husband of another patient

> gave

> similar testimony. There was additional evidence that the patients'

> activities were

> inconsistent with the descriptions on the claim forms. Some of them drove,

> cleaned

> house, gardened, bowled, and engaged in other active pursuits.

> The investigation also yielded evidence that the defendants knew that these

> twelve patients did not fit the descriptions on the claims. Both Wise

> and

> Wallace met a few of the patients in the PTS office, and Wise made some of

> the

> transports himself. Transfer forms were occasionally returned with notes

> from

> the

> paramedics indicating that family or friends picked up the patients from the

> treatment

> center, and some of the paramedics questioned Wise about the necessity

> of

> ambulance transport for patients who walked without assistance. Wise

> distributed a

> memo directing the paramedics to have all dialysis patients ride on

> stretchers and to

> take them into the treatment centers on stretchers. He also told paramedics

> and other

> employees that PTS had letters of medical necessity on file for the dialysis

> patients,

> but an FBI search uncovered no such letters relating to these twelve

> patients. One

> item discovered in the search was a note written by Wallace indicating that

> the

> -5-

> nephrologist treating Phyllis Warren, one of the patients, had advised that

> she did not

> need ambulance transport.

> The government also investigated two instances in which PTS " double hauled "

> by transporting two patients together in one ambulance and billing both

> accounts for

> the mileage. Neither were on stretchers; one patient rode in the front seat,

> and the

> other in the captain's chair. When the billing clerk at PTS noticed the

> coincidence of

> dates and times on the transfer forms, she asked Wallace and Wise how

> to

> prepare the claim forms because she did not believe the mileage could be

> reimbursed

> twice. She was nevertheless instructed to submit individual claims for each

> patient.

> The claim forms did not indicate that more than one patient had been

> transported, and

> each form claimed the full mileage for the trip.

> PTS, Wallace, Wise, and Wise were all charged with and

> acquitted of a conspiracy count that encompassed all 2,568 claims. The jury

> convicted PTS of twenty two counts of aiding and abetting false or

> fraudulent

> claims

> involving Medicare, in violation of 18 U.S.C. §§ 2 and 287, and two counts

> of

> false

> statements involving Medicaid, in violation of 42 U.S.C. § 1320a-7b.

> Wise

> was convicted of four counts of aiding and abetting false or fraudulent

> claims

> involving Medicare in connection with double hauling. Wallace was convicted

> of

> one count of aiding and abetting false or fraudulent claims involving

> Medicare in

> connection with the transport of Phyllis Warren. The court fined PTS

> $1,177,786,

> sentenced Wise to 30 months of imprisonment and a $6,000 fine, and Wallace

> to

> 100

> hours of community service in lieu of a fine.

>

> You can find the remainder of the 21 page opinion by putting in United

> States

> v. Patient Transfer Service, Inc., in Google, if you're interested in

> reading

> about the points on appeal.

>

> Wallace's sentence was upheld.

>

> The Court remanded the case to the District Court to reconsider the fine

> based upon PTS's contention that it lacks the ability to pay the fine due to

> losses and legal fees resulting from the defense of this case. There is a

> complex

> system for setting fines, and the Court can either reduce the fine, reimpose

> it, or raise it based upon the further evidence it will hear on that

> subject.

> Be careful what you ask for.

>

> The government won its appeal that Wise's sentence is too lenient, and the

> Court will reconsider. It is quite likely that his 30 month sentence could

> be

> increased. The sentencing Court gave him some credit for admitting guilt,

> which the Court of Appeals says the record does not support. So he may

> well

> find his sentence enhanced. Either way, he'll get to meet Bubba.

>

> Gene G.

>

> E.(Gene) Gandy

> POB 1651

> Albany, TX 76430

> wegandy1938@...

>

>

>

>

[Guest guest]

OK, here I go up on my soap box again..LOL. I DO agree that these

jokers should get everything that the government can throw at them

including the kitchen sink. Anybody that intentionally defrauds

medicare/medicaid like this should be hit with the BIG hammer. It's

theft, pure and simple. The ones they are really stealing from is

US. The honest people trying to do things the right way while they

line their pockets.

My main problem with the whole deal is what about the minor frauds

that steal services they aren't entitled to? I'm talking about the

ones that are on medicaid that call the ambulance at 0300 for a kid

that's had an ear ache for a week and is crying so much that Mama

can't sleep and says she has no other way to get to the hospital?

This isn't made up, I was on that run.

I work for a municipal service that's funded by the city and

county. As such, if they call and want to go, we have to haul em.

Natutally, the claim is denied, naturally they get a bill, naturally

they don't pay it. They know we can't refuse when they call, and

they know that if the only thing on their credit report is medical

bills, it doesn't go against them. Lending unstitutions don't even

take into account this type of non payment when considering a loan.

Until the PTB in Washington decide to make some changes, this type

of thing will continue to happen. I write honest reports. If

somebody walks to my rig, I put in that they walked and why. I do my

best to show why we should get paid for the run, but there are some

that you just can't without falsification and I refuse to do that.

Medicaid will pay a hospital for treatment of these folks, but WE

are left out in the cold. If medicaid deems there is no medical

necessity for an ambulance, they don't pay. Never mind the fact that

it costs every time you fire up a rig and make a run.

I have NEVER seen a case where something was done to individuals

for this type of abuse of the system. The PTB give excuses for not

changing things. If they do, people will be afraid to use the

system, kids and old folks won't get the care they need, etc, etc.

ad nauseum. Let you or me refuse to transport, and see who gets hit

with that BIG hammer. Never mind the fact that they weren't going to

pay anyway, the PTB will unload on us.

I'm not against medicaid by any means. The folks that need it

should have it, and they should be able to use our services as they

need them. What I AM against is the abusers. The ones that call the

ambulance to take Grandma to the hospital, and when you arrive there

are a dozen cars sitting around and the whole family in the house.

The ambulance got called because it's too much trouble for them to

wheel her to the car and lift her into the seat.

Until we get some changes, we'll continue to get runs that are

never paid and we'll continue to lose out. The PTB sit back in their

comfortable chairs and complain about the rising cost of health care

and do NOTHING to try and fix it (except cut funding and payments to

us honest folks).

An ambulance is just a money pit and a drain on the local economy

until YOU need it. An axiom that most politicians subscribe to.

I'll climb down now. Heights make me dizzy and I think I've used

about a quarters worth instead of my allocated 2 cents.

Thanks for listening to my ravings.

Joe Tollett

[Guest guest]

Tater,

Can you please explain what makes this illegal. I have never heard

that and I always try to learn something new today and today is your

day to teach me something new.

Thanks

stephen stephens

In , " E. Tate " <texaslp@y...> wrote:

>

> Joe,

>

>

>

> How would this bill end up on their credit report? Banks don't

take this information into account, because they know in most cases

that it is illegal that this information was included in the credit

report in the first place.

>

>

>

> There is a BIG difference in items on a person's credit report and

failure to pay just debt. EMS bills should never end up on the

patient's credit report. If one of these bills does, the person

whose report it ended up on has grounds for a HUGE lawsuit against

the provider that placed them there as well as whatever else the

FCRA allows.

>

>

>

>

>

> Now, the real question is… Why can't EMS decline a transport based

on the clinical evidence presented? I think at one time San

Francisco was triaging in the field. If they determined the

transport was not necessary the patient was given a bus token. When

is an earache ever a medically necessary transport? Why can't the

EMS crew assist grandma to the car for the ride to check her

bunion? EMS should then bill a " reasonable " amount for the assist

$50 or so should cover it.

>

>

>

> I too have transported patients that were not medically

necessary. Each ambulance should have a credit card machine in it.

If the transport is not deemed medically necessary they should have

to pay first. If they can't or won't pay, they can't ride.

>

>

>

>

>

> Tater

>

>

> joetemt_p <joetemt_p@y...> wrote:

> OK, here I go up on my soap box again..LOL. I DO agree that these

> jokers should get everything that the government can throw at them

> including the kitchen sink. Anybody that intentionally defrauds

> medicare/medicaid like this should be hit with the BIG hammer.

It's

> theft, pure and simple. The ones they are really stealing from is

> US. The honest people trying to do things the right way while they

> line their pockets.

> My main problem with the whole deal is what about the minor

frauds

> that steal services they aren't entitled to? I'm talking about the

> ones that are on medicaid that call the ambulance at 0300 for a

kid

> that's had an ear ache for a week and is crying so much that Mama

> can't sleep and says she has no other way to get to the hospital?

> This isn't made up, I was on that run.

> I work for a municipal service that's funded by the city and

> county. As such, if they call and want to go, we have to haul em.

> Natutally, the claim is denied, naturally they get a bill,

naturally

> they don't pay it. They know we can't refuse when they call, and

> they know that if the only thing on their credit report is medical

> bills, it doesn't go against them. Lending unstitutions don't even

> take into account this type of non payment when considering a loan.

> Until the PTB in Washington decide to make some changes, this

type

> of thing will continue to happen. I write honest reports. If

> somebody walks to my rig, I put in that they walked and why. I do

my

> best to show why we should get paid for the run, but there are

some

> that you just can't without falsification and I refuse to do that.

> Medicaid will pay a hospital for treatment of these folks, but WE

> are left out in the cold. If medicaid deems there is no medical

> necessity for an ambulance, they don't pay. Never mind the fact

that

> it costs every time you fire up a rig and make a run.

> I have NEVER seen a case where something was done to

individuals

> for this type of abuse of the system. The PTB give excuses for not

> changing things. If they do, people will be afraid to use the

> system, kids and old folks won't get the care they need, etc, etc.

> ad nauseum. Let you or me refuse to transport, and see who gets

hit

> with that BIG hammer. Never mind the fact that they weren't going

to

> pay anyway, the PTB will unload on us.

> I'm not against medicaid by any means. The folks that need it

> should have it, and they should be able to use our services as

they

> need them. What I AM against is the abusers. The ones that call

the

> ambulance to take Grandma to the hospital, and when you arrive

there

> are a dozen cars sitting around and the whole family in the house.

> The ambulance got called because it's too much trouble for them to

> wheel her to the car and lift her into the seat.

> Until we get some changes, we'll continue to get runs that are

> never paid and we'll continue to lose out. The PTB sit back in

their

> comfortable chairs and complain about the rising cost of health

care

> and do NOTHING to try and fix it (except cut funding and payments

to

> us honest folks).

> An ambulance is just a money pit and a drain on the local

economy

> until YOU need it. An axiom that most politicians subscribe to.

> I'll climb down now. Heights make me dizzy and I think I've used

> about a quarters worth instead of my allocated 2 cents.

> Thanks for listening to my ravings.

> Joe Tollett

>

>

>

>

>

>

[Guest guest]

Tater..if a debt is turned over to a collection agency, it is just

marked as unpaid medical with no information on the whys or

wherefors. It's only illegal if you include specifics just like any

other debt.

On refusing to transport, the politicos always say we work for the

tax payers and need to take care of them and then they sit back and

complain about how much it costs to operate (go figure LOL) Carry

Grandma to the car for them? Don't think we haven't tried that. It's

worked a few times, but it's usually a sensuous visit( since you was

here you might as well take her).

Small town politics are the same all over I guess. You try to tell

somebody that they don't need an ambulance and the next minute

they're on the phone to a city councelman or county commisioner and

you lose a couple pounds of butt. We do transfers here too, and on

those we try to explain what will and wont get paid and get an

acceptance of financial responsibility signed. Not that it makes any

difference, the ones that are going to pay will and the ones that

aren't wont.

My whole point is, that until the folks that hold the purse

strings realize what we're going through and make some changes,

things are going to stay like this. Unless the abusers are made to

face consequenses for the abuse, they'll continue to abuse. Human

nature I suppose, but there it is.

> OK, here I go up on my soap box again..LOL. I DO agree that these

> jokers should get everything that the government can throw at them

> including the kitchen sink. Anybody that intentionally defrauds

> medicare/medicaid like this should be hit with the BIG hammer.

It's

> theft, pure and simple. The ones they are really stealing from is

> US. The honest people trying to do things the right way while they

> line their pockets.

> My main problem with the whole deal is what about the minor

frauds

> that steal services they aren't entitled to? I'm talking about the

> ones that are on medicaid that call the ambulance at 0300 for a

kid

> that's had an ear ache for a week and is crying so much that Mama

> can't sleep and says she has no other way to get to the hospital?

> This isn't made up, I was on that run.

> I work for a municipal service that's funded by the city and

> county. As such, if they call and want to go, we have to haul em.

> Natutally, the claim is denied, naturally they get a bill,

naturally

> they don't pay it. They know we can't refuse when they call, and

> they know that if the only thing on their credit report is medical

> bills, it doesn't go against them. Lending unstitutions don't even

> take into account this type of non payment when considering a loan.

> Until the PTB in Washington decide to make some changes, this

type

> of thing will continue to happen. I write honest reports. If

> somebody walks to my rig, I put in that they walked and why. I do

my

> best to show why we should get paid for the run, but there are

some

> that you just can't without falsification and I refuse to do that.

> Medicaid will pay a hospital for treatment of these folks, but WE

> are left out in the cold. If medicaid deems there is no medical

> necessity for an ambulance, they don't pay. Never mind the fact

that

> it costs every time you fire up a rig and make a run.

> I have NEVER seen a case where something was done to

individuals

> for this type of abuse of the system. The PTB give excuses for not

> changing things. If they do, people will be afraid to use the

> system, kids and old folks won't get the care they need, etc, etc.

> ad nauseum. Let you or me refuse to transport, and see who gets

hit

> with that BIG hammer. Never mind the fact that they weren't going

to

> pay anyway, the PTB will unload on us.

> I'm not against medicaid by any means. The folks that need it

> should have it, and they should be able to use our services as

they

> need them. What I AM against is the abusers. The ones that call

the

> ambulance to take Grandma to the hospital, and when you arrive

there

> are a dozen cars sitting around and the whole family in the house.

> The ambulance got called because it's too much trouble for them to

> wheel her to the car and lift her into the seat.

> Until we get some changes, we'll continue to get runs that are

> never paid and we'll continue to lose out. The PTB sit back in

their

> comfortable chairs and complain about the rising cost of health

care

> and do NOTHING to try and fix it (except cut funding and payments

to

> us honest folks).

> An ambulance is just a money pit and a drain on the local

economy

> until YOU need it. An axiom that most politicians subscribe to.

> I'll climb down now. Heights make me dizzy and I think I've used

> about a quarters worth instead of my allocated 2 cents.

> Thanks for listening to my ravings.

> Joe Tollett

>

>

>

>

>

>

[Guest guest]

It's a " sensuous visit " with grandma? I'm going to need years of therapy to

overcome that image....

Rick LaChance

Tater..if a debt is turned over to a collection agency, it is just

marked as unpaid medical with no information on the whys or

wherefors. It's only illegal if you include specifics just like any

other debt.

On refusing to transport, the politicos always say we work for the

tax payers and need to take care of them and then they sit back and

complain about how much it costs to operate (go figure LOL) Carry

Grandma to the car for them? Don't think we haven't tried that. It's

worked a few times, but it's usually a sensuous visit( since you was

here you might as well take her).

Small town politics are the same all over I guess. You try to tell

somebody that they don't need an ambulance and the next minute

they're on the phone to a city councelman or county commisioner and

you lose a couple pounds of butt. We do transfers here too, and on

those we try to explain what will and wont get paid and get an

acceptance of financial responsibility signed. Not that it makes any

difference, the ones that are going to pay will and the ones that

aren't wont.

My whole point is, that until the folks that hold the purse

strings realize what we're going through and make some changes,

things are going to stay like this. Unless the abusers are made to

face consequenses for the abuse, they'll continue to abuse. Human

nature I suppose, but there it is.