AMR Reaches $600K Deal in Medicare/Medicaid Billing Dispute

Hartford Courant

The American Medical Response ambulance service has agreed to pay $600,000 to settle claims by the federal and state government’s that it improperly billed the Medicaid and Medicare government insurance programs for services.

The federal and state governments claimed that AMR billed for paramedic services at the scenes of emergency responses when in fact the services were performed by local fire departments, federal authorities said.

The settlement encompassed various types of service related to ambulance billing.

Advanced Life Support services involve services performed by a paramedic at the scene of an emergency and in the ambulance and they require a high level of medical monitoring. Basic Life Support services involve a lower degree of care that can be provided by an emergency medical technician or that relate to the transport of a patient in the ambulance to a hospital.

In several municipalities, fire departments provide advanced services when a 9-1-1 call is dispatched. In such situations, ambulance services such as AMR are dispatched to provide only basic ambulance transport. When fire departments and AMR respond jointly, it is called a “joint response.”

The federal and state governments claimed that AMR often billed Medicare and Medicaid for advanced services when it was only providing the basic service.

Federal officials said it would have been proper for AMR to bill Medicare for advanced services in situations in which it had a written billing agreement with a municipal fire department, something it did not have during the period subject to the settlement. In Medicaid cases, both AMR and municipal fire departments billed for advanced services, causing Medicaid to pay twice for one service, federal officials said.

AMR said in a statement Wednesday that officials with the company “can confirm that the company has resolved a billing misunderstanding related to Advanced Life Support (ALS) transports completed 2014–2019 in the state of Connecticut.”

“As part of the resolution, the company has implemented a new service agreement with a public partner and AMR has also agreed to a settlement with both the state and federal governments without any finding of liability. The new service agreement with the public partner will streamline joint operations going forward,” the statement said.

The AMR payment covers the period January 2014 through December 2019.

The case was investigated by the Office of Inspector General for the Department of Health and Human Services and the Connecticut Office of the Attorney General William Tong.