Sunday, December 13, 2015

President Of Ambulance Company Pleads Guilty To Perjury In Connection With Responding to Civil Investigative Demand for Documents in Health Care Claims Investigation

Health care fraud cases are more frequently being prosecuted as perjury cases. Fabricating documents or signing responses to subpoenas or requests for documents has been easier to prove than the alleged fraud

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. 

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.

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


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.