Air Methods Corporation has agreed to pay the federal government $1,050,873 to settle allegations that it violated the False Claims Act by improperly keeping overpayments for more than 100 flights that it knew to be medically unnecessary, the U.S. Government announced.
The United States alleged that Air Methods failed to return known overpayments for flights that did not meet the coverage requirements of federal healthcare programs, including Medicare and Kentucky Medicaid. These programs only provide reimbursement for air ambulance transportation if the beneficiary’s medical condition requires air transport, and transport by ground ambulance is not appropriate, officials said.
Air Methods’ internal review process identified flights that did not meet these coverage requirements, including instances where patients were flown despite not meeting trauma criteria. However, Air Methods allegedly failed to return the overpayments for these flights, and instead kept the money for itself, regulators said.
The False Claims Act is a federal law that prohibits causing the submission of false or fraudulent claims to the federal government. It also forbids knowingly concealing, avoiding, or decreasing an obligation to pay the government. As such, healthcare providers can face False Claims Act liability when they fail to return known overpayments to federal healthcare programs.
“Healthcare providers have a legal obligation to return known overpayments received from the federal government,” said Carlton S. Shier, IV, United States Attorney for the Eastern District of Kentucky. “It is critically important to all of us that such misapplied funds are returned to their purpose – providing necessary medical care – and that we take the steps necessary to protect the limited resources available to these vital programs.”
The unnamed person who first filed the complaint will receive about $190,000 from the settlement.
