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Case Number: 3:18-CV-00043
Judge: Gregory F. VanTatenhove
Court: United States District Court for the Eastern District of Kentucky (Fayette County)
Plaintiff's Attorney: United States Attorney’s Office in Lexington
Defendant's Attorney: Brandon Marshall
Description: Lexington, Kentucky criminal defense lawyer represented Defendant charged with failing to return known overpayments received from Medicare, Kentucky Medicaid, Tricare, and the Department of Veterans Affairs in violation of the False Claims Act.
The United States alleged that Air Methods violated the False Claims Act, by improperly retaining overpayments for more than 100 flights that it knew to be medically unnecessary and, therefore, ineligible for reimbursement by federal healthcare programs. Federal healthcare programs, including Medicare and Kentucky Medicaid, only provide reimbursement for air ambulance transportation if the beneficiary’s medical condition requires air transport, and transport by ground ambulance is not appropriate. The United States alleged that Air Methods’ internal review process identified flights that did not meet these coverage requirements, including instances where patients were flown despite not meeting trauma criteria. The False Claims Act, a federal law that prohibits causing the submission of false or fraudulent claims to the federal government, also forbids knowingly concealing, avoiding, or decreasing an obligation to pay the government. As such, healthcare providers also face False Claims Act liability when they fail to return known overpayments to federal healthcare programs.
“Healthcare providers have a legal obligation to return known overpayments received from the federal government,” said Carlton S. Shier, IV, United States Attorney for the Eastern District of Kentucky. “It is critically important to all of us that such misapplied funds are returned to their purpose – providing necessary medical care – and that we take the steps necessary to protect the limited resources available to these vital programs.”
"Federal health care programs are an important resource for millions of Americans to receive medical care," said Tamala E. Miles, Special Agent in Charge at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). "HHS-OIG will continue to promote the proper use of federal health care funds and their protection from fraud, waste, and abuse."
The settlement resolves a lawsuit brought by a private citizen under the qui tam provisions of the False Claims Act. Under those provisions, a private party can file a civil action on behalf of the United States, thereby bringing allegations of fraud to the Government’s attention, and share in any financial recovery. As part of this resolution, the individual who filed the qui tam complaint will receive approximately $190,000 from the settlement.
This case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General, the Department of Defense, Defense Criminal Investigative Services, and the Affirmative Civil Enforcement section of the U.S. Attorney’s Office. Assistant United States Attorneys Benjamin Long and Mary Melton represented the United States.
Outcome: 08/15/2023 44 NOTICE of Settlement Voluntary Dismissal of Air Methods Corporation by Scott Crum, USA (Long, Benjamin) Modified on 8/15/2023 (CBD). (Entered: 08/15/2023)
08/15/2023 ***FILE SUBMITTED TO CHAMBERS of Judge Van Tatenhove for review: re 44 NOTICE of Settlement Voluntary Dismissal of Air Methods Corporation (CBD) (Entered: 08/15/2023)
Settled for $1 million.