The operator of an ambulance company that primarily served nursing homes and other outpatient care sites has been sentenced to 30 months in federal prison after pleading guilty to defrauding Medicare and Medicaid.
Joseph Valdie Kimble, the former operator of the Longview, Texas-based Tiger EMS, must also pay more than $750,000 in restitution to the two federal payers, according to a statement from the U.S. Attorney’s Office for the Eastern District of Texas released last week.
The federal government alleged that Tiger EMS had provided ambulance services to patients that did not qualify under Medicare and Medicaid; in order to bill for non-emergency medical transportation, providers must prove that the beneficiary is bedridden and/or cannot safely use other forms of transportation to medical appointments.
“Kimble disregarded medical necessity requirements and billed Medicare and Medicaid for ambulance services provided to patients for whom ambulance transport was not medically necessary,” the U.S. attorney’s office noted in a statement announcing the sentencing and fine.
Tiger EMS primarily shuttled skilled nursing facility residents to hospitals and dialysis centers, the government noted.
Various government agencies — including the federal Department of Health and Human Services (HHS) Office of the Inspector General (OIG) and the Department of Justice (DOJ) — have long gone after health care providers for fraud, typically by seeking financial judgments under the False Claims Act.
But the DOJ has indicated a growing willingness to pursue criminal charges and jail time in medical fraud cases, with a specific focus on nursing home operators.
“We need to go after cases civilly because they a [sic] providing grossly substandard care and, in the appropriate case, refer it for a parallel criminal prosecution,” associate deputy attorney general Toni Bacon told Bloomberg Law last fall. “As America’s aging, it’s becoming a larger problem and we need to be able on the federal side to identify who is the worst of the worst.”
Philip Esformes, the executive behind what the government described as the largest health care fraud case in U.S. history, this past September received a 20-year prison sentence after being convicted on 20 counts. Esformes — who, federal officials alleged, defrauded Medicare and Medicaid of more than $1 billion — was also ordered to relinquish $44 million in forfeiture judgments and other penalties.
In addition to the jail time, Kimble must serve three years of supervised release, during which time he cannot work in the health care industry.
The OIG, the federal government’s top health-fraud watchdog, conducted the investigation in conjunction with the Texas Attorney General’s Medicaid Fraud Control Unit, with assistant U.S. attorneys Alan Jackson and Frank Coan presenting the case.