In a press release, the US Department of Justice (DOJ) reported a substantial settlement between the US, several states and EmCare, Inc., one of America’s largest emergency staffing companies of physicians.
The company agreed to pay the US almost $6.5 million and several states more than $1.2 million. These payments will settle Medicaid fraud charges that it overcharged several federal health care insurance programs many millions of dollars.

A whistleblower, Theresa Semtner, initiated the suit but died before its conclusion. Her estate will receive approximately $1.5 million for her role in uncovering the Medicaid fraud and initiating the action.

The DOJ explained how the company committed its actions. It hired an Oklahoma City biller, Emergency Physicians Billing Services (EPBS), to file

claims on its behalf to both state and federal health care programs.

EPBS then submitted false Medicare, Medicaid, CHAMPUS and FEHBP claims on behalf of EmCare for patients seen by its physicians.

EPBS would, according to the government, change health care claims codes to higher classifications and more expensive procedures than doctors performed or provided.

These false claims were then submitted to federal agencies as part of the Medicaid fraud, resulting in the higher and illegal payments.

"All firms participating in the federal government's health care insurance program should know that the United States will not tolerate fraud or cheating," said Assistant Attorney General Frank W. Hunger.

In addition to the fines, EmCare, in an agreement with The Office of the Inspector General of the Department of Health and Human Services, agreed to voluntarily enroll in a Corporate Integrity Program to change its performance going forward.

The program will ensure EmCare’s compliance with laws and regulations concerning participation in Medicare programs. One requirement is that the company bring in an independent organization to review its billing policies and practices on an annual basis.

Have information on Medicaid Fraud?

If you have information about Medicaid fraud, contact the Medicaid Fraud Reporting Center for a confidential claim evaluation today. You may report Medicaid fraud by completing the form on this page, or by calling our Medicaid Fraud Hotline at 1-800-934-2921.