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CT AG Settles with American Medical Response for $602K Medicaid Overbilling

American Medical Response of ConnecticutMarch 29, 2022Connecticut Attorney General

Penalty Amount

$626,759

Summary

Connecticut Attorney General William Tong announced a $601,759 settlement with American Medical Response of Connecticut (AMR-CT) for overbilling the state Medicaid program by billing for Advanced Life Support services when only Basic Life Support was provided, and even when local fire departments had already provided and billed for those services. AMR-CT also entered a consent agreement with the Department of Public Health requiring it to cease improper billing, comply with reporting requirements for one year, and pay a $25,000 civil penalty.

Remedy

AMR-CT must cease billing for Advanced Life Support unless it is the recognized provider in the service area or an exception applies, cease fraudulent billing, comply with DPH quarterly reporting and compliance monitoring for one calendar year, and pay a $25,000 civil penalty.

Monetary PenaltyConsent DecreeInjunctionAudit RequirementCompliance Program

Contract Impact

In-house legal teams should review all healthcare service provider agreements, particularly those involving ambulance/emergency medical services and government payors like Medicaid. Focus on clauses defining service levels (e.g., Advanced Life Support vs. Basic Life Support), billing and reimbursement certifications, representations and warranties regarding claim accuracy, compliance with applicable state and federal healthcare laws, audit and monitoring rights, and penalties for false or fraudulent billing. Changes may be needed to require explicit documentation standards for service levels billed, incorporate clear definitions aligned with state responder laws, add mandatory reporting to payors of billing discrepancies, and strengthen indemnification provisions for overpayment recoveries.

Contract Search Terms

service level certificationbilling accuracy requirementsMedicaid reimbursement ratesfalse claims preventionaudit rightscompliance monitoringprovider agreement termsclaims submission protocolsreimbursement scheduleadvanced life support (ALS) vs basic life support (BLS)

Violation Types

Entity Details

Entity

American Medical Response of Connecticut

Also known as: American Medical Response

Industry

Healthcare

Official Sources

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