U.S. Department of Justice
Peter F. Neronha
United States Attorney
District of Rhode Island
November 2, 2011
R.I. AMBULANCE COMPANY OWNER SENTENCED TO 24 MONTHS IN FEDERAL PRISON FOR HEALTH CARE FRAUD; ORDERED TO PAY MORE THAN $700,000 IN RESTITUTION
PROVIDENCE, R.I. – The owner and president of a Warwick, R.I., ambulance company was sentenced today to 24 month in federal prison, 3 years supervised release and 1,000 hours of community service for defrauding health care programs administered by Medicare and Blue Cross Blue Shield of Rhode Island of more than $700,000.
John M. Almon, 55, of Cranston, R.I., owner and president of Med Care Ambulance LLC, was also ordered by U.S. District Court Judge William E. Smith to make full restitution in the amount of $625,825.31 to the Medicare Program and $78,292.25 to Blue Cross Blue Shield.
Almon pleaded guilty in June 2011 to two counts of health care fraud, and one count each of obstruction of a federal audit and making false statements.
At the time of his guilty plea, Almon admitted to the Court that beginning in March 2008 and continuing until December 2010, he obtained payments in excess of $700,000 from Medicare and Blue Cross Blue Shield, by improperly submitting claims for reimbursement that falsely and fraudulently represented that Med Care had provided medically necessary Specialty Care ambulance transportation.
Almon admitted that he routinely solicited Medicare beneficiaries to be transported on a routine basis to renal care facilities for dialysis treatments, the majority of which was routine in nature and did not require advanced or specialty care. He also admitted that he actively solicited Medicare beneficiaries to agree to be transported for dialysis treatments by waiving the co-payment that the beneficiary would be liable for once Medicare or Blue Cross determined the amount that they would pay for services. By waiving co-payments, Med Care removed the monetary obstacle a patient might have had, and thus would agree to be transported by Med Care.
In addition, Almon admitted that he obstructed federal auditors contracted by the U.S. Department of Health and Human Services during their investigation by instructing members of his executive staff to gather documents responsive to a Medicare Audit, and to “clean them up” and ensure there are no “red flags.” Almon also admitted to knowingly making false statements and representations during a meeting with federal agents and prosecutors while attending a meeting in the office of the United States Attorney.
The case was prosecuted by Assistant U.S. Attorneys Luis M. Matos and Dulce Donovan.
The matter was investigated by the U.S. Department of Health and Human Services – Office of the Inspector General in Boston.