FOR IMMEDIATE RELEASE CIV WEDNESDAY, MAY 21, 1997 (202) 616-2765 TDD (202) 514-1888 EMCARE INC. TO PAY U.S. AND STATES $7.75 MILLION FOR HEALTH CARE BILLING FRAUD, START INTEGRITY PROGRAM WASHINGTON, D.C. -- One of the nation's largest emergency physician staffing companies, EmCare Inc., today agreed to pay the United States and various states $7.75 million to settle allegations it overcharged several federal health care insurance programs millions of dollars, according to the Department of Justice. The payments allegedly stemmed from false claims its billing company submitted to the federal agencies. Assistant Attorney General Frank W. Hunger of the Civil Division said EmCare will pay the United States almost $6.5 million and various states more than $1.2 million to resolve allegations of false billings to the Medicare, Medicaid and CHAMPUS programs and the Federal Employees Health Benefits Program (FEHBP). "All firms participating in the federal government's health care insurance program should know that the United States will not tolerate fraud or cheating," said Hunger. "One of the Department's highest priorities is to discover and prosecute any and all federal health care program swindlers." The Department said EmCare hired an Oklahoma City billing company, Emergency Physicians Billing Services (EPBS), to submit claims on its behalf to federal and state health care programs. EPBS then submitted false Medicare, Medicaid, CHAMPUS and FEHBP claims on EmCare's behalf for patients seen by EmCare physicians. The United States alleged that EPBS typically changed the codes of health care claims to reflect more expensive medical procedures than what was actually performed and billed for services more extensive than those actually provided by EmCare's physicians. The Office of the Inspector General of the Department of Health and Human Services and EmCare agreed separately to a "Corporate Integrity Program" in which EmCare agreed to undertake measures to ensure compliance with applicable laws and Medicare rules and regulations in the future. The program requires, for example, that EmCare contract with an independent professional organization to review EmCare's billing policies, procedures and practices on an annual basis. The agreement settles a dispute with EmCare originally brought as a qui tam case in U.S. District Court in Oklahoma City in United States ex rel. Semtner v. Emergency Physicians Billing Services, Civil Action No. Civ-94-617-(C) (W.D. OK). As part of the settlement, the estate of Theresa Semtner, who filed the suit on behalf of the United States, will receive approximately $1.5 million. The United States is continuing to pursue recoveries against other defendants in the action, as well as other customers of EPBS. The case was conducted by the Civil Division, with the assistance of HHS' Inspector General offices in Washington, D.C., and Dallas, Texas; the Oklahoma City office of the FBI; the Tulsa Resident Agency of the Defense Criminal Investigative Service; the Program Integrity Branch of the Office of CHAMPUS; the Office of Inspector General for the Office of Personnel Management in Washington, D.C.; and various state attorney general Medicaid fraud control units around the country. Additional audit support was provided by Xact, the Medicare intermediary in Pennsylvania, and the Mailhandlers Plan of the FEHBP. ##### 97-214