United States: Roadmap To Prison: Lessons Learned From The Criminal Prosecution Of Alpha Ambulance’s Leaders

No one running an ambulance company ever planned to go to prison for doing his or her job. But that is a real possibility if the government knocks on the door, and the owner or manager is dishonest in his or her response to the inquiry. CMS contractors are increasing the number of audits they are performing of ambulance companies. Similarly, HHS-OIG and the Department of Justice are increasing the number of ambulance companies that they are investigating. How the owners and managers of ambulance companies react to these inquiries can have far-ranging consequences for those individuals and their companies. Take for instance the owners and managers of now defunct Alpha Ambulance ("Alpha") from Los Angeles County. Faced with a CMS contractor audit and a lack of strong documentation for prior submissions, company personnel admitted in their plea agreements that they altered records and patient files in response to an audit, and at least one person provided materially false statements to federal agents during an interview. The result: convictions and lengthy prison sentences after being indicted for conspiracy to commit health care fraud, as well as conspiracy to obstruct an audit and making a materially false statement to a federal agent. There are proper, legitimate ways to address documentation problems when being audited. These defendants failed to understand the importance of being both honest and transparent with the CMS contractor auditors. They are personally paying the price for their errors with the pain and shame of having to spend years in federal prison.

According to court documents, Alpha specialized in the provision of non-emergency ambulance transportation services to Medicare beneficiaries, primarily dialysis patients. According to the charges, knowing that the beneficiaries' medical conditions did not necessitate non-emergency ambulance transportation services, the owners of Alpha, Alex Kapri and Aleksey Muratov, conspired with Alpha General Manager Wesley Kingsbury and Training and Education Supervisor Danielle Medina to submit false claims to Medicare. As seen in other health care fraud cases, the Indictment alleged that co-conspirators instructed employees to document a justification for each transport even if one did not exist and to avoid certain words that would trigger non-payment. However, what the company leadership did next possibly transformed what could have been an expensive but non-criminal civil False Claims Act enforcement matter into a criminal case resulting in harsh sentences.

In March 2012, CMS contractor Safeguard Services notified Alpha that Alpha would be subject to a Medicare audit and requested production of 60 patient files and related documentation. This is certainly a relatively routine event in the EMS industry. Alpha employees collected the requisite patient files, and Kingsbury and Medina conducted an internal review. Unfortunately the documentation was not ideal. To deal with the documentation problems, Kapri, Muratov, Kingsbury, and Medina altered records and instructed others to alter the files to justify the transports. According to evidence adduced at trial, Alpha created a secret room with a light tracing table and a paper shredder where Alpha employees created false run tickets and destroyed original records. Of course, this type of conduct is what converted what could have remained a civil case into a criminal case.

Then, in April 2012, federal agents contacted Kingsbury regarding Alpha's response to the CMS contractor audit. Kingsbury then disclosed to Kapri and Muratov the names of the agents and the questions the agents asked. The following day, HHS-OIG and FBI special agents questioned Kingsbury regarding his conversation with Kapri and Muratov. Kingsbury lied. He denied that he disclosed the names and questions of the agents to Kapri and Muratov.

In September 2012, a federal grand jury charged Kapri, Muratov, Kingsbury, and Medina with conspiracy to commit healthcare fraud, health care fraud, and conspiracy to obstruct a federal audit. Kingsbury was also charged with making a materially false statement to law enforcement officers.

In October 2013, Kapri, Muratov, and Medina pleaded guilty to conspiracy to commit healthcare fraud and received sentences of 75 months, 108 months, and 30 months, respectively. Kingsbury maintained his innocence through two trials but ultimately pleaded guilty to conspiracy to commit Medicare fraud, conspiracy to obstruct a Medicare audit, and making materially false statements to law enforcement officers. He was sentenced to 78 months.

According to the FBI's press release regarding this case, the FBI and HHS-OIG investigated this case together with the Medicare Fraud Strike Force. The Medicare Fraud Strike Force is part of the HHS and DOJ's joint Health Care Fraud Prevention and Enforcement Action Team (HEAT) created in May 2007. During 2014, HEAT Strike Force efforts resulted in the filing of charges against 228 individuals or entities, 232 criminal actions, and $441 million in fines or recoveries.

In sum, the leaders of Alpha Ambulance erred in how they reacted to the audit and the follow up from the audit. If they had been transparent about their documentation problems, they likely would have had to pay monies to the government to address the problem, but might have avoided criminal prosecution. The early involvement of counsel can help company leadership comply with legal obligations and avoid mistakes and obstructive conduct. In addition, suggested steps in response to an audit request may include:

  • Gather responsive records;
  • Assess if there are problems or gaps in the responsive records;
  • If no problems or gaps, produce the records;
  • If problems or gaps, consult with legal counsel to discuss lawful options;
  • If there are significant problems, legal counsel will likely take over all communications with the auditors;
  • Understand that the responsive records will nonetheless likely still need to be produced by the company, regardless of the involvement of counsel;
  • Any communication with the auditors needs to be truthful and forthright;
  • No records can be altered, amended, back-dated, thrown out, or purged;
  • If a person is approached by a federal agent, politely decline the interview, contact legal counsel, and then determine with counsel's advice if a later scheduled interview would be helpful or not; and
  • Remember that anyone approached for an interview by a federal agent has a Fifth Amendment right not to answer questions.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
 
In association with
Related Topics
 
Related Articles
 
Related Video
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions