LEXINGTON, Ky. (WKYT) - Officials have served a lawsuit to Powell County's fiscal court alleging Medicare fraud. The complaint accused Powell County EMS of billing the federal government for Medicare for transfers that were not medically necessary.
"When you bill the federal government, we're all paying for that. They're stealing our money," Chris Miller, who represents the whistle blower in the lawsuit, told WKYT's Miranda Combs. Miller said they believe there have been 2400 fraudulent transfers since 2012. "One of the rules is if you can walk to the ambulance it's not medically necessary," he explained.
Miller said his client has proof that EMS would mark a run on a 'transport sheet' as medically necessary when they were not. "They were pre-marking these transfers as medically necessary before even evaluating the patient," he said. "$300 to $600 a transfer is being paid by the federal government to take these folks that do not qualify for the service."
WKYT has covered different EMS providers in rural parts of the state. It is a regular occurrence for tax-based services, like Powell County's, to transport patients to doctor's appointments. That's legal. But Miller said Powell County was taking an extra alleged illegal step, by billing Medicare for bogus reasons. "When they do those transfers that aren't medically necessary, and they bill the federal government for those transfers. That's fraud," said Miller.
"You think this is happening in other counties?" Combs asked.
"No doubt about that. This is not the only place this is going on. This is an issue that they're seeing more and more of," Miller said.
WKYT reached out to the Powell County judge executive. He said he's limited in what he can say because this is an open legal matter. Judge James Anderson said he's fairly confident that if there had been any merit to some of the allegations, the medical director or billing company would have picked up on it.
Under the False Claim Act, damages can be three times the amount of billing. Plus, civil penalties of $11,000 per event.