Ambulance Company Reaches Settlement with Government in Civil Case

North Haven-based Nelson Ambulance Service and Access Ambulance of Bridgeport have settled a civil case with the government to resolve allegations that they improperly billed the Medicare and Medicaid programs.

The ambulance companies, which have the same ownership and have mini bases in Stratford, Stamford and Greenwich, will pay $595,000 in the settlement.

The government alleges that Nelson and Access routinely billed for non-emergency, scheduled ambulance services that were not medically necessary, according to Tom Carson, spokesman for the United States Attorney District of Connecticut Office.

The medically unnecessary ambulance services were provided to Medicare and Medicaid beneficiaries being transported to and from their regularly scheduled dialysis treatments, according to Carson. Patients transported by Nelson and Access were typically picked up at their residences or at nursing homes and transported by ambulance to and from dialysis treatment three times per week.

Carson said in a press release that relevant regulations indicate that medical necessity for ambulance transport is established when the patient’s condition is such that the use of any other means of transportation is contraindicated. The regulations indicate that the patient must be “bed confined” or otherwise have a medical condition such that transportation by ambulance is medically required.

The government alleges that Nelson and Access, which have the same ownership, regularly transported patients by ambulance, at an average cost of approximately $380 for each round trip, when the patients did not meet the criteria of being “bed confined” or otherwise have a medical condition requiring transportation by ambulance.

Some of the same patients Nelson and Access regularly transported by ambulance were transported to and from other doctor’s visits utilizing a wheelchair van, at an average cost of only $60 for each round trip.

To resolve their liability, Nelson and Access will pay $595,000 for conduct occurring between January 2008 and August 2013.

In entering into the civil settlement agreement, Nelson and Access did not admit liability.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.