Tricare Fraud Case Leads to $5.5M Settlement With Fla. Ambulance Company

A Florida ambulance company has settled a case of alleged Tricare fraud and Medicare fraud that has led to more than $5.5 million. The case was originally started by a whistleblower.

False Claims Act Case Based on Medicare and Tricare Fraud Allegations

The False Claims Act allegations were lodged against AmeriCare arguing that it defrauded government health care programs, such as Tricare, by using unnecessary transportation services with an ambulance. Tricare fraud and other forms of government fraud are targeted aggressively by authorities.

Whistleblowers, as in this case, often share vital information about possible fraud. Under the False Claims Act, the government can decide whether or not they want to intervene.

Federal prosecutors alleged that Tricare fraud had occurred between January of 2008 and December of 2016 in which thousands of fraudulent reimbursement claims were submitted to the Medicare and Tricare programs. The Tricare fraud False Claims Act lawsuit alleged that non-emergency ambulance transports were not actually required for the patients.

AmeriCare must enter into an integrity program directly with the U.S. Department of Health and Human Services Inspector General and will have to pay $5.5 million to resolve these allegations. Federal agency audits and information from AmeriCare employees who came forward as whistleblowers were used to build the case of alleged Tricare fraud and Medicare fraud.

Damaging testimony that came from management over the course of the investigation, according to the United States Department of Justice, was also a critical factor in determining fault and responsibility.

The evidence that the government had previously obtained in addition to the Tricare fraud allegations made by the whistleblower indicated that AmeriCare had engaged in a scheme involving thousands of false documents and reports. This was used as evidence of systemic fraud costing millions of dollars of taxpayer money.

A whistleblower case was originally filed regarding the Tricare fraud in 2013 by a former employee.

Direct evidence, in conjunction with whistleblower insight, may become the basis of the legal claim against charged parties. The involvement of a whistleblower under the False Claims Act comes with protections for the employee from retaliation in addition to a possible portion of the recovery.

Government Intervenes in Tricare Fraud Case to Pursue Charges and Recovery

In early 2017, the federal government and Florida informed the court that they would not be intervening in the case. However, they changed their mind later that year and opted to intervene that summer. As a result of his participation in Tricare fraud  case, the whistleblower will receive more than $1 million of the settlement proceeds.

This type of award is typical in False Claims Act cases in which the whistleblower’s testimony or information is critical for building a case over Tricare or any type of fraud against the government.

If you believe you have grounds to file a whistleblower case based on Tricare fraud or other government fraud, you need to consult with experienced attorneys at Bradley/Grombacher today by filling out the form on this page.

The Tricare fraud lawsuit is U.S., et al. ex rel. Sharp v. AmeriCare Ambulance, Case No. 8:13-cv-1171 in the U.S. District Court for the Middle District of Florida.

Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.