I have urged clients for years not to alter or add to records for this exact reason. In addition, changing the records can be used to show proof of fraudulent intent. When records are incomplete or missing, there are ways to address the issues.
In a recent case, the president of a nonemergency ambulance transportation company pleaded guilty to Perjury in North Carolina for producing records under oath that the records she produced were responsive to a Civil Investigative Demand (CID). In fact, some of the records were fabricated.
On November 5, 2015, Jamime Leonard Smith, the president of CCMT, Inc., doing business as Crystal Coast Medical CCMT, Inc., doing business as Crystal Coast Medical Transport (CCMT) pleaded guilty to a felony count in federal court. CCMT was a nonemergency ambulance transportation company.
In
2012, CCMT and its president Smith became the subject of investigation after a
member of the public videotaped CCMT employees routinely transporting patients
in CCMT ambulances when the patients had the ability to walk or ride in
wheelchairs.
Medicare and TRICARE generally do not cover nonemergency ambulance transportation services when the patient has the ability to walk or ride in a wheelchair. Additionally, for reimbursement to be covered by Medicare and TRICARE, the ambulance company must obtain an order, known as a Physician’s Certification Statement (PCS), from the patient’s physician indicating that the ambulance trip is medically required.
Medicare and TRICARE generally do not cover nonemergency ambulance transportation services when the patient has the ability to walk or ride in a wheelchair. Additionally, for reimbursement to be covered by Medicare and TRICARE, the ambulance company must obtain an order, known as a Physician’s Certification Statement (PCS), from the patient’s physician indicating that the ambulance trip is medically required.
In
October of 2013, the United State Attorney’s Office for the Eastern District of
North Carolina issued a CID upon CCMT,
to the attention of its president Ms. Smith. The CID required CCMT to produce to the
government, “Any and all Physician Certification Statements on which you relied
to provide ambulance transport to any beneficiary of a government healthcare
program, including but not limited to Medicare, Medicaid, or TRICARE for the
time period January 1, 2011 [to] the present.”
In November of 2013, Ms. Smith produced records and swore under oath that the records she produced were responsive to the CID. In fact, the investigation revealed that in many instances, Ms. Smith or someone under her direction had altered the PCS forms to include additional markings that were not made by the patients’ physicians.
In some instances, PCS forms were fabricated to cover dates of service for which no genuine PCS form existed. In other instances, the PCS forms were altered to include additional markings that were not made by the patient’s physician. For example, some PCS forms were altered to indicate that the ambulance transport was medically necessary, or to reflect that the patient had additional illnesses or medical conditions justifying the ambulance transport. In no instance did the physicians authorize Ms. Smith or any other agent of CCMT to fabricate or alter PCS forms for their patients.
In November of 2013, Ms. Smith produced records and swore under oath that the records she produced were responsive to the CID. In fact, the investigation revealed that in many instances, Ms. Smith or someone under her direction had altered the PCS forms to include additional markings that were not made by the patients’ physicians.
In some instances, PCS forms were fabricated to cover dates of service for which no genuine PCS form existed. In other instances, the PCS forms were altered to include additional markings that were not made by the patient’s physician. For example, some PCS forms were altered to indicate that the ambulance transport was medically necessary, or to reflect that the patient had additional illnesses or medical conditions justifying the ambulance transport. In no instance did the physicians authorize Ms. Smith or any other agent of CCMT to fabricate or alter PCS forms for their patients.
At
sentencing, Ms. Smith faces up to 5 years in prison and 3 years of
supervise release. She also faces a fine of up to $250,000 and
restitution if ordered by the court.
When your company receives a Civil Investigative Demand for records or Grand Jury Subpoena or Civil Subpoena, seek legal advice in responding to it.
Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
When your company receives a Civil Investigative Demand for records or Grand Jury Subpoena or Civil Subpoena, seek legal advice in responding to it.
Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
