NEW BERN — A federal prosecutor has filed a complaint against a Carteret County-based medical transport company for alleged fraudulent billing of thousands of dollars to the health care programs Medicare, Medicaid and TRICARE. 

Thomas Walker, U.S. Attorney for the Eastern District of North Carolina, filed the action Feb. 19 with the U.S. District Court for the Eastern District of North Carolina against Crystal Coast Medical Transport (CCMT), a non-emergency medical transport company based at 534 N. 35th St. in Morehead City.

Mr. Walker alleges the company filed false and fraudulent claims to Medicare, the health care program for seniors; Medicaid, the health care program for low-income families; as well as TRICARE, the health program for uniformed service members, retirees and their families. The claims were for reimbursement ambulance transport.

The complaint named Kenneth Lohr of Highway 24 west of Morehead City as the relator, a person who provided a government agency with information on which a legal complaint is based, also known as a whistleblower. News-Times staff contacted Mr. Lohr, but he declined to comment on his involvement with the complaint. 

Mr. Walker is seeking a trial by jury for this complaint. He’s asking for triple damages for submission of false claims and for false statements to get a claim paid. 

Mr. Walker is also seeking equal amounts in damages for money paid under misrepresentation of facts and equal amounts in damages for unjust enrichment. He’s also seeking reimbursement for the cost of the legal action, plus interest, and investigative costs as provided by the law, as well as any other relief deemed just by the court. 

According to the complaint, the company filed claims for reimbursement with the programs on ambulance trips that weren’t medically necessary. While the three programs reimburse companies for emergency ambulance trips, they only reimburse for non-emergency trips when the patient has no other means of getting to a hospital, such as bedridden patients who need to make regular treatment visits. 

“From at least November 2010 through the present, CCMT billed Medicare, Medicaid and TRICARE for ambulance transports that were not medically necessary,” the complaint says, “including non-emergency, scheduled, repetitive ambulance services of patients to and from routine outpatient dialysis treatment.” 

The complaint alleges that in some cases, CCMT altered paperwork to make it look like they were complying with regulations. Medicare requires written orders from a patient’s attending physician before it will cover non-emergency, regular ambulance services. These orders are referred to as physician certification statements or certificates of medical necessity. 

The complaint alleges CCMT falsified and fabricated PCS’s in a number of cases. It says some of the patients for whom CCMT was requesting reimbursement were able to sit in a wheelchair or stand; others were able to walk, didn’t require stretcher service and had other means of getting to their treatment besides an ambulance. 

The complaint includes six examples of its allegations. The patients’ names were abbreviated to initials in order to protect their privacy. 

Each of the example patients had been transported by ambulance for routine outpatient dialysis treatments. They’d been taken by ambulance to their appointments multiple times, with CCMT billing Medicare, Medicaid and TRICARE each time. 

The most expensive case was for a patient who’d been transported three times a week from Oct. 29, 2010, to at least Jan. 15. According to the complaint, CCMT billed Medicare $573,927.75 for the transports between Nov. 1, 2010, and Sept. 30, 2013, at an average cost of $650.71 per trip.

Medicare paid $351,066.74 for the trips. TRICARE had been billed $29,067.78 as a secondary payer for trips from Oct. 29, 2010, to July 24, 2013; it paid the full amount.

CCMT officials did not respond by presstime.

Contact Mike Shutak at 252-726-7081 ext. 206, email mike@thenewstimes.com; or follow on Twitter at @mikesccnt.

(11) comments

Core Sounder

I do not claim to know that much about transporting folks to the Hospital or doctor offices at taxpayers expense but I do support the program. Just wondering why the County doesn't provide transportation for this since I see lots of county vehicles that claim to be for this purpose. Besides does it really need to cost 600 plus dollars to give an individual a ride to Carteret General? 3 times a week at 600 dollars each would be foolish not to move that individual into one of the apartments near the hospital. Reckon that saving taxpayer money is not one of the priorities in the first place . Anyways if CCMT is indeed guilty as charged then lets hope the court system hangs their butts out to dry but I am not very hopeful on this since so much waste is allowed to occur in our medical system and our jails could not hold all the guilty folks that abuse this system in the first place.

Drime

Core Sounder you are right and there is a county based transportation system called CCATs. But then again CCATs is funded by the Fed,State ,and county tax dollars. Money made from this service would offset the cost to the local taxpayers .Why wouldn't these Medical facilities use one of the local Taxi Companies or CCATs for their patients needs ?
Then again the investigation may find out these medical facilities may have been getting some kick back in one way or another.[wink]

Marks Law Group

This type of fraud is endemic within the Non-Emergency Medical Transport industry. Either the states need to crack down on this, or the federal government will be filing many more of these lawsuits.

morehood city res

better lawyer up crazy jaymee

David Collins

It's not just transport. The home health care supply business, from catheters to power chairs and magic knee braces needs to be looked at closely. There are scammers behind every tree and Govt. controlled health care is an easy mark.

The county does provide transport. Those little white CCAT busses. You do have to make prior arrangements and cost but a dollar. Thanks taxpayers. Life really is good.

E94EVER

Even though the county has CCATS, they do not transport bedridden folks. These Medical transport companies pick-up and drop people off in their homes and some go as far as Duke hospital. They provide a needed service and I'm sure it's quite a lucrative business without filling bogus claims to the insurance companies. Looks like the upstart Friendly transport will benefit from this.

Drime

Would not surprise me if Friendly transport is doing the same thing as CCMT.
Take notice they have handicapped mini vans just like CCMT . Only a ambulance is allowed a NC license tag that is not for hire. But a mini van is not a ambulance an therefore should have a for hire licence plate ! Friendly transport has several Mini Vans ! And E94EVER , a mini van does not transport bedridden folks either !

jercoop

As a former cab driver, in the county, for over 17 years, Carteret General Hospital, has a fund, to pay for cab rides, for patients!! Don't know where the money comes from, but would fill out a form and sign, it and receive a cash payment, to transport a patient, the most I ever received was $35.00, for a transport from the hospital to Snug Harbor, normal cab fare!! Most were in the $7.00 to $10.00 range, for local transport!! All were regular cab fare's, consistent with the ride!! I don't know anything about the bedridden patients, having to go to Duke, or other Hospital's, but have to ask why patients, have to go so far, when we have a State Of the Art, Hospital, in our community?? In the past, Carteret General, may have been sub par, but today, we have a fantastic hospital, with a very qualified staff, who can prove they are among the best in this state, for medical care!! We don't have a major trauma unit, but I can understand, why! Our community, is much too small, to support such a unit!! Since moving here, I am proud of the success, of our hospital, we now have a cancer center, and can offer treatment, that just a couple of years ago was miles away! For as small community, we have a lot to be grateful for!!

Jerry Cooper,
Beaufort

Native

Well people I have enjoyed seeing the different point of views but what happened to the comment that was here after jercoop's post? That comment was very interesting as it described how Mr. Lohr was somehow associated with Ronald Stone, and where Mr. Lohr got his possible information from?? I am not sure why this post was deleted but I find it to be very fascinating if there is an actual connection between Mr. Lohr and Ronald Stone (Owner of Friendly Medical Transport). Hopefully the News-Times will keep us updated as this event carries on and expose if there really is any connection between Mr. Lohr and Ronald Stone.

E94EVER

Drime, I was responding to why CCATS can't be used. Not all patients can walk or use a wheel chair. These companies charge based on how they have to transport the patient whether they are able to use a wheel chair or are bedridden etc. The vehicle they use are based on these needs as well. I'm quite familiar with how it works and the paperwork involved that gets filled out and verified. I wouldn't throw stones on want you think may be happening just because their in the same business. Stick to what you know and you'll be smarter for it...

E94EVER

Jercoop, not all patients go to the hospital, these transport companies take them to doctor appointments as well and yes they go to Duke, Greenville etc. Not all are capable of walking. They also take people home from the ER who can't quite walk yet and are not capable of taking a taxi. People really need to go and see what they do and how they do it, before posting the nonsense that I see here.

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