Ambulance Company Manager Sentenced to 78 Months in Prison for $5.5 Million Medicare Fraud Scheme
The general manager of a Southern California ambulance company was sentenced today to 78 months in federal prison for his role in a $5.5 million scheme to defraud the Medicare program.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney Stephanie Yonekura of the Central District of California, Special Agent in Charge Glenn R. Ferry of the U.S. Department of Health and Human Services, Office of Inspector General’s (HHS-OIG) Los Angeles Region and Assistant Director in Charge Bill Lewis of the FBI’s Los Angeles Field Office made the announcement.
Wesley Harlan Kingsbury, 34, of Bloomington, California, pleaded guilty on Sept. 15, 2014, to one count of conspiracy to commit health care fraud, one count of conspiracy to obstruct a Medicare audit and one count of making materially false statements to federal law enforcement officers. In addition to the prison sentence, U.S. District Judge Dale S. Fischer of the Central District of California ordered Kingsbury to pay $1,338,413 in restitution.
According to admissions made in connection with his guilty plea, Kingsbury was the general manager of Alpha Ambulance Inc. (Alpha), which specialized in the provision of non-emergency ambulance transportation services to Medicare beneficiaries, primarily to and from dialysis treatments. Kingsbury admitted that between April 2010 and July 2012, he conspired with the owners of Alpha, Alex Kapri and Aleksey Muratov, and the training supervisor, Danielle Medina, to bill Medicare for ambulance transportation services for individuals that did not need to be transported by ambulance. In addition, as general manager, Kingsbury instructed emergency medical technicians employed by Alpha to conceal the true medical condition of patients they were transporting by altering paperwork and creating false justifications for the transportation services.
In early 2012, Medicare notified Alpha that they would be subject to a Medicare audit. In response, Kingsbury admitted that he and his co-conspirators altered patient documentation to falsely justify the ambulance transportation services. Specifically, Kingsbury admitted that he and others used light tracing tables to trace over original documents and create falsified patient documentation for submission to Medicare. They then shredded the original patient documents.
Kingsbury and his co-conspirators submitted $5,522,079 in fraudulent claims to Medicare, and Medicare paid $1,338,413 on those claims.
Further, according to admissions in connection with Kingsbury’s guilty plea, in April 2012, Kingsbury was approached by law enforcement officers and asked to assist with the investigation into Alpha. Kingsbury disclosed to the owners of Alpha the names of the law enforcement officers who were conducting the investigation and the questions they had asked. On May 1, 2012, Kingsbury falsely denied to the law enforcement agents that he had disclosed that information to the owners of Alpha.
Kapri, Muratov and Medina pleaded guilty to conspiracy to commit health care fraud on Oct. 28, 2013. They were sentenced to 75 months, 108 months, and 30 months in prison, respectively.
The case was investigated by the FBI and the Los Angeles Region of HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. The case was prosecuted by Trial Attorneys Blanca Quintero and Alexander F. Porter, and Assistant Chief Ben Curtis of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.