Pikeville Medical Center to Pay $4.39 Million to Resolve Alleged Controlled Substance Act Violations That Allowed Drug Diversion
LEXINGTON, KY -An ambulance services company in Floyd County agreed to pay the U.S. Government $948,000 to settle civil allegations that it billed federal health care programs for medically unnecessary services over the course of several years.
According to the settlement agreement, from February 1, 2006 until December 31, 2012, Lafferty Enterprises, LLC, doing business as Trans-Star Ambulance Services, transported Medicare patients to and from dialysis clinics by ambulance when an ambulance transport was not medically necessary. The government contends that Trans-Star violated the False Claims Act by billing Medicare for routine, non-emergency ambulance transports provided to patients who were able to safely travel to and from the dialysis clinics by other means. Medicare covers non-emergency ambulance transports only when all other forms of patient transportation are considered a medical risk.
“It is vitally important that the resources available to federally funded healthcare programs be used only to pay for medically necessary services,” said Kerry B. Harvey, U.S. Attorney for the Eastern District of Kentucky. “Our office and our agency partners are committed to protecting the integrity of these important programs on which so many of our citizens depend.”
In addition to the payment of the settlement amount, Trans-Star has agreed to enter into a corporate integrity agreement with the Department of Health and Human Services-Office of Inspector General (HHS-OIG), which obligates Trans-Star to undertake substantial internal compliance reforms and to commit to a third-party review of its claims to federal health care programs for the next three years.
The settlement was based on the penalties associated with the alleged violations and Trans-Star’s financial ability to pay.
The investigation and settlement stem from a complaint filed by a former owner of another ambulance company in eastern Kentucky, pursuant to the whistleblower provisions of the False Claims Act, which permit private individuals to bring a lawsuit on behalf of the United States. The whistleblower, Kevin Fairlie, will receive $189,600.
The investigation was conducted by the Department of Health and Human Services, Office of the Inspector General; the Office of the Kentucky Attorney General, Medicaid Fraud and Abuse Control Unit (“MFCU”) and the U.S. Attorney’s Office.