You are on page 1of 24

Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 1 of 22 - Page ID#: 1

Eastern District of Kentucky

FI l ED

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF KENTUCKY
CENTRAL DIVISION
LEXINGTON

UNITED STATES OF AMERICA, ET AL. )
EX REL. [UNDER SEAL]
)
)
)
)
Plaintiff,
)
)
)
v.
)
)
[UNDER SEAL]
)
)

CASE NO. ~
-.;

APR 2 4 2015
AT LEXINGTON
ROBERT R. CARR
CLERK U.S. DISTRICT COURT

· \~s -c \,/- os~J·- m+\

Qui Tam COMPLAINT

FILED UNDER SEAL
DO NOT FILE ON PACER UNLESS UNSEALED BY COURT ORDER

Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 2 of 22 - Page ID#: 2

Ea.stern District of Kentucky

FILED

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF KENTUCKY
CENTRAL DIVISION
LEXINGTON

APR 2 4 2015
AT LEXINGTON
ROBERT R. CARR
CLERK U.S. DISTRICT COURT

UNITED STATES ex rel.
DARRELL STEPHEN MCINTOSH
BRINGING THIS ACTION ON
BEHALF OF THE UNITED STATES OF
AMERICA

Case No: 5:/'S- C:v-/D 5-JAA.H

c/o Kerry Harvey
United States Attorney
230 W. Vine Street, Suite 300
Lexington, KY 40507-1612
-andc/o Eric H. Holder, Jr.
Attorney General of the United States
Department of Justice
1oth & Constitution Avenue, N. W.
Washington, D.C. 20530
Plaintiff,

v.
ARROW-MED AMBULANCE, INC.

Serve: Hershel Jay Arrowood
68 Shacks Lane
Jackson, KY 41339
Defendant.

QUI TAM COMPLAINT

Comes the Relator, Darrell Stephen Mcintosh, by and through the undersigned counsel,
and on behalf of the Plaintiff, the United States of America, alleges based upon personal
1

31 U. Arrow-Med billed for non-qualified ambulance transport through Medicare by utilizing the services of an individual as an EMT. Inc. against the Defendant.S. the Relator has been informed that the unnecessary medical transports were routinely accomplished by exaggerating the conditions of patients on documentation. the Defendant's fraudulent scheme caused the submission of false claims for payment to government healthcare programs. As a result. as follows for his Complaint under the Federal False Claims Act.S. Also. The scheme is a violation of AntiKickback laws. In addition. and (iii) violating anti-kickback laws with referral sources. INTRODUCTION This is an action brought pursuant to the Federal False Claims Act. by the Relator. § 3729-3733. Inc. The medically unnecessary ambulance transports by the Defendant include the transportation of patients to and from kidney dialysis clinics where the patients demonstrated no medical necessity for such transportation. (ii) billing for non-qualified ambulance transport. Arrow-Med Ambulance. to recover reimbursements obtained from Medicare and other government programs by the Defendant. et seq. 2 . 31 U. when the individual was not licensed to provide these services.Page ID#: 3 knowledge and relevant documents. Furthermore. Arrow-Med engaged in a swapping scheme with a nursing home wherein Arrow-Med provided deeply discounted runs billable to the nursing home in exchange for referrals for Medicare Part B patients. including run reports and claims for reimbursement submitted through Medicare. The fraudulent submissions made by the Defendant include (i) medically unnecessary nonemergency ambulance transport.C. § 37293733. Arrow-Med Ambulance..C..Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 3 of 22 . Darrell Stephen Mcintosh. et seq.

Arrow-Med Ambulance.S. 3 . Kentucky ("MCINTOSH").Page ID#: 4 PARTIES 1. § 3732(a) and 28 U. ARROW-MED is a licensed ambulance agency operator with the Kentucky Board of Emergency Medical Services ("KBEMS").S.S. and complained of herein took place in part in this District and the Defendants transacted business in this District: a. Darrell Stephen Mcintosh. Breathitt County. Mcintosh Ambulance Services. ARROWMED does business as "Breathitt County Ambulance" and "Wolfe County Ambulance". § 1391 because the acts proscribed by 31 U. §§ 3732(a) and 3730(b). Kentucky. is a recognized ambulance agency operator in Breathitt County. The Relator.C. Inc. as the owner of Mcintosh Ambulance Services. The Defendant. JURISDICTION AND VENUE 3. Jurisdiction in this Court is proper pursuant to 31 U. is a Kentucky corporation with its principal place of business in Jackson. The principal of ARROW-MED is Hershel Jay Arrowood. §§ 3729 et seq. 4. Breathitt County. during the relevant time periods.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 4 of 22 . and venue is proper in this Court pursuant to 31 U. MCINTOSH has personal knowledge of the facts and allegations contained in this Complaint by virtue of his position. Inc.C. At all times relevant to this Complaint.S.C. This Court also has jurisdiction pursuant to 28 U. Breathitt County.C. Inc. is an individual residing in Jackson. According to publicly available records on KBEMS. Kentucky ("ARROW-MED"). ARROW-MED operated an ambulance service in Jackson. § 1331. 2.C.S. The Court may exercise personal jurisdiction over the Defendants. Kentucky..

5. Pursuant to 31 U. This disclosure statement was supported by material evidence known to the Relator at the time of filing that establishes the existence of Defendants' false and fraudulent claims. and was submitted to those Federal officials in their capacity as counsel for the United States . of which he is the original source. 5 U. LEGAL BACKGROUND A.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 5 of 22 . 31 U. § 552.S.the Relator understands this disclosure to be confidential and exempt from disclosure under the Freedom of Information Act. and a statement of all material evidence and information in his possession. c. was substantially amended by the False Claims Amendments Act of 1986 and signed into law on October 17. 1986. On numerous occasions from January 26.Page ID#: 5 b. Because the disclosure statement included attorneyclient communications (including common interest privilege) and work product of Relator's attorneys. The Federal False Claims Act ("FCA").S.C. § 3729(c). ARROW-MED provided patient transport to patients who were beneficiaries of Medicare for which there existed no medical necessity for such transport in the District.a potential and real party in interest in this action . the Relator prepared and served the original Complaint on the Attorney General of the United States. d. The United States made payments.C. originally enacted in 1863 during the Civil War. Federal False Claims Act 6. for benefits under Medicare Parts A and B to ARROW-MED within this District. Many of ARROW-MED's patients who receive frequent and routine transport for which there is no medical necessity reside in this District. directly or indirectly. 2012 to current date.C. and the United States Attorney for the Eastern District of Kentucky.S. Congress enacted these amendments to enhance the 4 . § 3730(b)(2).

plus three times the amount of damages that the Government sustains as a result of the defendant's actions. 2010. Congress established the Medicare program of health insurance for the elderly and disabled. improperly submitted reimbursement claims under Medicare and other federally-funded healthcare programs by billing for the provision of medically unnecessary ambulance transportation.Page ID#: 6 Government's ability to recover losses sustained as a result of fraud against the United States and to provide a private cause of action for the protection of individuals who act in furtherance of the purposes of the Federal False Claims Act. § 3729(a).C.C. ARROW-MED.S.500 and not more than $11.000 per false claim. § 3729(a)(l )(B). 31 U. Congress amended the FCA as a part of the Fraud Enforcement Recovery Act of 2009 on May 20. established a federally subsidized health insurance program. Medicare provides reimbursement for healthcare benefits. The Medicare Act. B. 8. as adjusted for inflation. In 1965.S. including pharmaceutical drugs and supplies. Medicaid 9. 31 U. 10. items and services. It provides reimbursements to participating 5 . 7.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 6 of 22 . The complaint is to be filed under seal for 60 days (without service on the Defendant during such 60-day period) to enable the Government: (a) to conduct its own investigation without the Defendant's knowledge and (b) to determine whether to join the action. It amended the FCA again as part of the Patient Protection and Affordable Care Act on March 23. § 3731. 42 U. The Defendant. making certain amendments retroactive. 2009. including 31 U.S. as part of the Social Security Act.C. 11.S. Medicare Part A and Part B.C. § 1395 et seq.. Violations of the FCA subject the defendant to civil penalties of not less than $5.

primarily low income and disabled persons.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 7 of 22 . through contracted intermediaries. Medicare pays only for those services that are "reasonable and necessary for the diagnosis or treatment of illness or injury".. § 1395y(a)(l)(A). Medicaid provides healthcare benefits for certain groups. The Defendant ARROW-MED is a participating ambulance service provider in federally-funded healthcare programs including Medicare. The fraudulent practices discussed herein involved reimbursements under both Medicare Part A and Part B. 12.C. is based on each state's per capita income compared to the national average.. Medicaid is administered and funded in part with federal funds. 19. 42 U. including separately payable ambulance services. or directly to its beneficiaries.C. 14. known as the Federal Medical Assistance Percentage. Part A authorizes the payment of federal funds for hospitalization and post-hospitalization care. Part B authorizes the payment of federal funds for medical and other health services. 15. C. Medicare consists of two parts. 17. 1395x(s)(7). ] but only to the extent provided in regulations. 16. The federal involvement in Medicaid includes providing matching funds and ensuring that states comply with minimum standards in the administration of the program.S. 13. Medicare covers ambulance services only "where the use of other methods of transportation is contraindicated by the individual's condition [ .S.Page ID#: 7 healthcare providers on behalf of its beneficiaries. Reimbursement for Ambulance Services 18. 6 . The federal share of Medicaid payments." 42 U.

and (4) for 7 . the following criteria must be met: (1) the beneficiary is unable to get up from bed without assistance. repetitive ambulance services are reimbursed only if the beneficiary's physician certifies that the medical necessity requirements are met. (2) the beneficiary is unable to ambulate.F. or if a patient's medical condition is such that the ambulance transportation is medically required. the transport must be medically necessary.R.40(d)(l).F. Nonemergency. § 410.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 8 of 22 .R. 42 C. 24. and (3) the beneficiary is unable to sit in a chair or wheelchair. To be considered bed-confined. Non-emergency transportation by ambulance 1s reimbursable only if the beneficiary is bed-confined and it is documented that the beneficiary's condition is such that other methods of transportation are contraindicated. Medicare covers four kinds of ambulance transportation subject to the requirement that the transports are medically necessary: (1) from a point of origin to a hospital or skilled nursing facility ("SNF") capable of furnishing the required level of care. 23. scheduled. To be reimbursable under Medicare Parts A and B. Nonemergency ambulance services that are either unscheduled or that are scheduled on a non-repetitive basis are also reimbursed only under specific circumstances enumerated in 42 C.40(d)(3).Page ID#: 8 20. the beneficiary's medical condition must require both the ambulance transportation itself and the level of service provided in order for the billed service to be considered medically necessary. § 410. 410. Id 22. (3) to and from a SNF to the nearest supplier of medically necessary services unavailable at the SNF where the beneficiary resides.F. 21. (2) from a hospital or SNF to the beneficiary's home. Thus.40(d)(2).R. no earlier than sixty (60) days before the date the service is furnished. 42 C.

F. including medical van 8 .R.40(e). 1(6). Similarly. Furthermore Medicare regulations require ambulance service providers to adequately staff both emergency and non-emergency transport vehicles in order to be eligible for reimbursement. 8. a Basic Life Support ("BLS") vehicle must be staffed by an individual who is "certified as an emergency medical technician by the state or local authority". a Class I BLS ambulance must at a minimum be staffed by one (1) emergency medical technician and one (1) first responder. and the service is the least expensive available transportation for the patient's needs. complete and return the designated CMS form and provide the carrier with emergency vehicle and staff licensure and certification requirements.4l(b)(l)(i).Page ID#: 9 beneficiaries receiving renal dialysis treatment for End-Stage Renal Disease to and from the beneficiary's home to the nearest facility that furnishes renal dialysis. 42 C. the patient is traveling to or from a Medicaidcovered service. Sec. Kentucky state regulations regarding the reimbursement of ambulance transport through Medicaid similarly require that the transport be "medically necessary".Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 9 of 22 . 907 KAR 1:060 Sec. 25. 202 KAR 7:501.R. upon a Medicare carrier's request. 30.41(c)(2). An ambulance supplier must. Pursuant to 42 CFR 410. § 410. 907 KAR 1:060. 27. exclusive of a pharmacy service. Alternative transportation methods are available for individuals whose medical condition does not necessitate the use of ambulance transport. 28. 4. § 410. under Kentucky regulations. Medicaid reimburses non-emergency ambulance services only if the patient's medical condition warrants transport by stretcher. 42 C. 29. 26.F. Sec.

. 42 9 . §§ 242(b) and (c). See Social Security Amendments of 1972. The statute provides in relevant part: (b) Illegal remuneration [ .000 or imprisoned for not more than five years. prohibits any person from offering or paying remuneration in order to induce or reward referrals for services paid for under federal healthcare programs. or (B) to purchase. The AKS is violated if any one purpose of the remuneration is to induce or reward referrals of federal health care program business. 42 U. Pub. 92-603. overtly or covertly. No.. The AKS arose out of Congressional concern that providing things of value to those who can influence healthcare decisions may corrupt professional healthcare decisionmaking. 4.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 10 of 22 . § 1320a-7b(b).C.S. 31. or even harmful to a vulnerable patient population. 918 (Jan. or both. shall be fined not more than $25. 66 Fed. of poor quality. Medical van transportation is serviced in the area of Breathitt County through Middle Kentucky Transportation. service. leasing or ordering any good. 42 U.C. order or arrange for or recommend purchasing. L. in cash or in kind to any person to induce such person (A) to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program. commonly referred to as the Anti-Kickback Statute ("AKS"). shall be guilty of a felony and upon conviction thereof. ] (2) whoever knowingly and willfully offers or pays any remuneration (including any kickback. facility. bribe or rebate) directly or indirectly. § 1320a-7b(b)(2). or item for which payment may be made in whole or in part under a Federal health care program. 856. The Medicare and Medicaid Patient Protection Act. Reg.S. 34. and may result in federal funds being diverted to pay for goods and services that are medically unnecessary. lease. Inc. 33. 32. The AKS prohibits payment of kickbacks in order to protect the integrity of Medicare. 2001).Page ID#: 10 transportation.

Medicare and Medicaid Patient and Program Protection Act of 1987. ARROW-MED. Pub. FACTUAL ALLEGATIONS/ FRAUDULENT SCHEME 37. and (C) providing kickbacks to a referral source. it does so subject to and under the terms of its certification to the United States that the services for which payment is sought were delivered in accordance with federal law. L.C. The Defendant. ARROW-MED routinely transported patients for dialysis treatments where there was no medical necessity for the transport. The fraudulent activity raised by the Relator in this Qui Tam Complaint involves three fraudulent schemes: (A) medically unnecessary non-emergency ambulance transport.Page ID#: 11 U. L.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 11 of 22 . the Defendant entered into agreements with selected healthcare facilities to provide ambulance service to the Medicare Part A patients at prices far below the MFS rate. 95-142. A. 38. regularly and fraudulently submitted claims for payment to government healthcare programs. When a provider submits a claim for payment. No. 100-93. 35. including. 10 . Defendants offered or paid remunerations to induce healthcare facilities to hire Defendants for services for which payment may be made in whole or in part under a government healthcare program. § 1320a-7b.S. regularly provided transportation for government healthcare beneficiaries who were able to ambulate and did not meet the material conditions to be eligible for payment. Medicare-Medicaid Antifraud and Abuse Amendments. No. (B) billing for non-qualified ambulance transport. 40. the AKS. without limitation. 36. For example. and on information and belief. At all times material to the Complaint. Medically Unnecessary Non-Emergency Ambulance Transport 39. Pub. the cost to Defendants. ARROW-MED. The Defendant.

Wednesday. 44. 1 Patient names are abbreviated to maintain each patient's confidentiality. failed to meet the medical necessity requirements permitting reimbursement from Medicare. 45. she was routinely transported approximately twelve (12) miles by ARROW-MED. On numerous instances. 2014. Patient JB was able to ambulate and transport herself to and from the kidney dialysis treatment center. the Relator witnessed Patient JB engaging in behavior that indicated that her medical condition did not reflect the medical necessity for the use of ambulance transport. The examples of unnecessary medical transport for kidney dialysis patients include patients such as Patient JB. Patient DS. and Patient DE. Many of the patient transports. 48. Patient VR. Patient CE. Patient CH. 2014. Patient JB received kidney dialysis treatment three times per week: Monday. on September 10. 11 . and as a result of his familiarity with citizens in the community.Page ID#: 12 41. including those of dialysis patients. Friday. Despite Patient JB's lack of medical necessity for ambulance transport. 42. The following day. 1 43. Patient JB was viewed by Relator on a stretcher outside of the kidney dialysis treatment center being transported in an ambulance identified as "ARROW-MED" for transport. 49. 46.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 12 of 22 . Despite the medical need for the kidney dialysis treatment. Patient JN. 47. On September 9. Patient ST. Patient JB was viewed by Relator demonstrating physical ability that would indicate that Patient JB was able to transport herself including driving a motor vehicle and pumping gas. Inc. The Relator is familiar with Patient JB's medical condition as a result of the services he performed with Mcintosh Ambulance Services.

2014. 2014 transport of Patient ST and Patient DS constituted a "double transport" which if reported properly. Patient JB 's physical ability did not demonstrate the medical necessity for ambulance treatment. The lack of medical necessity for Patient DS was so apparent during the transport that ARROW-MED permitted Patient DS to ride in the front seat of the ambulance. 12 . December 23. Inc. results in lower Medicare reimbursements. and August 20. During these occasions. 2014. 2014. By way of further example. the Relator was informed by employees of Mcintosh Ambulance Services that ARROW-MED transported Patient DS for kidney dialysis treatment. Patient JB was also viewed by Relator or by employees of Mcintosh Ambulance Services. 52. the Relator was informed by employees of Mcintosh Ambulance Services that ARROW-MED transported Patient ST for kidney dialysis treatment. Inc. 2014. By way of further example. the Relator is familiar with Patient ST's medical condition as a result of the services he performed with Mcintosh Ambulance Services. Patient ST received kidney dialysis treatment transports from ARROW-MED.Page ID#: 13 50. 55. 54. On or around October 17. 51. and as a result of his familiarity with citizens in the community. 2014. 56.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 13 of 22 . On or around October 17. Inc. the October 17. 53. the Relator is familiar with Patient DS's medical condition as a result of the services he performed with Mcintosh Ambulance Services. 57. In addition to being medically unnecessary. and as a result of his familiarity with citizens in the community. On July 30. Patient DS received kidney dialysis treatment ambulance transport from ARROW-MED that lacked medical necessity.

Inc. 61. the Relators has been informed by staff for Fresenius Medical dialysis clinic in Jackson. By way of further example. has also been informed by a former employee of ARROW-MED that ARROW-MED pressured paramedics and Emergency Medical Technicians ("EMT") to exaggerate patients' medical conditions for purposes of justifying patient transports on patient run reports. 62. By way of further example. Relator was informed that Patient CE received kidney dialysis treatment transports from ARROW-MED that lacked medical necessity. The Relator. 65.Page ID#: 14 58. that ARROW-MED transports patients that lack medical necessity for the non-emergency transport. 59. Patient DS received kidney dialysis treatment transports from ARROW-MED that lacked medical necessity. Relator was informed that Patient CH received kidney dialysis treatment transports from ARROW-MED that lacked medical necessity. MCINTOSH. and as a result of his familiarity with citizens in the community. the Relator is familiar with Patient VR's medical condition as a result of the services he performed with Mcintosh Ambulance Services. 63. Kentucky. By way of further example. 64. 13 . The clinic manager also informed Relator that ARROW-MED had solicited the business of Medicare dialysis patients. The Relator has personally witnessed a number of ARROW-MED's patients transported to kidney dialysis centers who were able to walk outside for the purpose of smoking cigarettes. 60. Relator was informed that Patient DD received kidney dialysis treatment transports from ARROW-MED that lacked medical necessity. demonstrating the lack of medical necessity. By way of further example.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 14 of 22 . These patients were dropped off at the waiting room of the clinic by ARROW-MED and were able to walk without assistance. In addition.

69.Page ID#: 15 66. Because Employee KM was not a licensed EMT. the Relator. ARROW-MED did not have the staff licensed or qualified to operate the ambulances for the runs to obtain Medicare reimbursements. patient transports were not reimbursable under Medicare regulations. The Relator.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 15 of 22 . 2 The employee's name is abbreviated to protect the employee's privacy. ARROW-MED was continuously searching for EMTs and paramedics to employ through newspaper advertisements. ARROW-MED continued to allow Employee KM to perform EMT services for ARROW-MED and sought and obtained reimbursement from his services as though he was properly licensed. 2015 to a nursing home. As a result. hereinafter referred to as Employee KM 2. Billing/or Non-Reimbursable Ambulance Transport 67. ARROW-MED utilized the services of an employee whose license was suspended byKBEMS. 73. had his license suspended or revoked by KBEMS in December 2014. B. 74. 14 . MCINTOSH has been informed by former employees of ARROW-MED that ARROW-MED pressured employees to forge a physician's signature on the physician certification statement in furtherance of the fraudulent scheme to obtain Medicare reimbursements. Furthermore. By way of example. 72. the Relator is aware that Employee KM was involved in a non-emergency patient transport on March 10. The EMT. 70. 71. MCINTOSH has witnessed ARROW-MED utilizing the services of an individual in the capacity of an EMT even though the individual lacked proper credentials to act in the capacity of an EMT. 68.

The submission of runs for Medicare reimbursement by Employee KM are fraudulent because the runs were not qualified for Medicare reimbursements by the staffing requirements of state and federal regulations including 42 CFR 410.41(b) and 202 KAR 7:501. 77. a nursing home known as the "Nim Henson Geriatric Center" ("NHGC") entered into a swapping scheme with ARROW-MED to receive deeply discounted patient transports in exchange for referrals for Medicare Part B referrals. 82. As a nursing home. 78. 8. The Relator. 81. C. 2012. A nursing home is responsible for payments under Medicare Part A to compensate an ambulance service provider for medical transport that lacks a reimbursable medical necessity. At or soon after ARROW-MED commenced operating business on January 26. 15 . the NHGC is a significant referral source to ambulance service providers. NHGC is a referral source under the AKS to an ambulance service provider like ARROW-MED. Sec. 79. ARROW-MED offers NHGC significantly discounted rates on transport for Medicare Part A patients to NHGC.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 16 of 22 . MCINTOSH. or a "skill" as it is frequently referred to. Providing Kickbacks to Referral Sources 76.Page ID#: 16 75. 80. has knowledge regarding ARROW-MED's engagement in a referral swapping scheme with a referral source. A patient of a nursing home who has a "skill" may be transported and the transport may be reimbursable under Medicare Part B.

Inc. 2012. During this period. was ten (10) to twenty (20) referrals per month. 2012. ARROW-MED's deeply discounted patient transport under Medicare Part A operates as a "kickback" to NHGC for the right to transfer all of NHGC's patients under Medicare Part B. did not receive any referrals except for the rare and limited circumstance when ARROW-MED was unable to fulfill NHGC's transfer requests due to prior commitments. including Medicare Part B patients. Also. 88.Page ID#: 17 83. Mcintosh Ambulance Services. provided services to NHGC prior to January 26. The Relator has knowledge of this fraudulent scheme as a result of his services provided for and on behalf of Mcintosh Ambulance Services. 85. to ARROW-MED for patient transport. 87. 86. with a monthly list of "skilled" patients so Mcintosh Ambulance Services. Once ARROW-MED began operating business. 89. 84. Inc. Inc. Inc. Inc. received from NHGC prior to the commencement of the fraudulent scheme on January 26. NHCG would provide Mcintosh Ambulance Services. NHGC exclusively refers its patients. 16 . After the commencement of the fraudulent scheme. The Relator estimates that the number of referrals for runs that Mcintosh Ambulance Services. NHGC discontinued transmitting the monthly list of "skilled" patients to Mcintosh Ambulance Services.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 17 of 22 . Inc. In exchange for the deeply discounted rates. Inc. Inc. Mcintosh Ambulance Services. The Relator estimates that this would occur once every three (3) to four (4) months. As a result. would have knowledge on how to appropriately bill for these patient transports. NHGC discontinued the use of Mcintosh Ambulance Services.

the fraudulent schemes complained of above are on- going by ARROW-MED.C. COUNT I . 95. Through the foregoing conduct. 92.Page ID#: 18 90. § 3729(b)(l)(A)) of the claims' false or fraudulent nature because the Defendant knew that the claims were being submitted for Medicare reimbursement and the Defendant 17 . false or fraudulent claims for payment or approval. The Relator also discovered a written directive instructing NHGC personnel to use only ARROW-MED for the transport of Medicare Part A patients. in violation of the False Claims Act. on behalf of Mcintosh Ambulance Services. Relator repeats each and every allegation of Paragraphs 1 through 93 of this Complaint with the same force and effect as if set forth herein. 31 U.C.SUBMISSION OF FALSE CLAIMS FEDERAL FALSE CLAIMS ACT. which fraudulent scheme commenced upon the inception of ARROW-MED on January 23. 94. 31 U. ARROW-MED had knowledge (as defined by the False Claims Act.S. including. submitted a competitive bid to NHGC but NHGC refused to respond to the bid from Mcintosh Ambulance Services. except for the scheme involving Employee KM.S. ARROW-MED.S. 2012 and continues to date upon presumption and belief. 2015. without limitation. 96. or caused to be presented. The Relator has obtained information that Employee KM obtained his EMT license on or around March 26. ARROW-MED knowingly presented. et seq. The claims relevant to this Count include all claims within the fraudulent scheme of the Defendant. 91. 31 U. On information and belief.C. claims for ambulance transport that were not reimbursable and lacked medical necessity for reimbursement. §§ 3729(a)(l)(A).Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 18 of 22 . 97. 93. The Relator. Defendant. § 3729(a)(l)(A). The Relator has been informed by an agent of NHGC that they only use ARROW-MED because ARROW-MED gives them a "better rate''.

false records or statements material to false or fraudulent claims. or caused to be made or used. Relator repeats each and every allegation of Paragraphs 1 through 93 of this Complaint with the same force and effect as if set forth herein. ARROW-MED. physician certification statements and other requests for reimbursement which were intended to mislead Medicare into providing reimbursement for services that were not qualified for reimbursement. in violation of the False Claims Act. is liable to the United States for treble damages under the FCA. the Defendants. §§ 3729(a)(l)(B}. COUNT II .Page ID#: 19 knew that the patient transports lacked medical necessity to justify reimbursement under the applicable federal or state regulations regarding reimbursement.000 for each false claim presented or caused to be presented by Defendant.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 19 of 22 . ARROW-MED submitted claims for payment in amounts that were falsely inflated or exaggerated. 102. Defendants knowingly made. 18 . 103. 98. Defendant.C.S. 101.S. plus a civil penalty of $5.USE OF A FALSE RECORD FEDERAL FALSE CLAIMS ACT. 31 U. 100. the United States suffered damages. in violation of the AKS. et seq.C. § 3729(a)(l)(B). Defendant. in an amount to be determined at trial. Through the foregoing conduct. The false or fraudulent records or statements relevant to this Count include all run reports. used. and claims for payment for services rendered to patients unlawfully referred to ARROW-MED by referral sources and others to whom ARROW-MED provided kickbacks and/or illegal remuneration and/or with whom ARROW-MED entered into prohibited financial relationships. By virtue of the false or fraudulent claims presented or caused to be presented by 99.500 to $11. 31 U.

2012 and continues to date upon presumption and belief. the Relator.. ARROW-MED.000 for each false claim presented or caused to be presented by Defendant. Inc. 106. ARROW-MED.000 be imposed for each and every false claim that Defendant caused to be presented to the United States and/or its grantees.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 20 of 22 . the United States suffered damages. 31 U. §§ 3729 et seq. Arrow-Med Ambulance. PRAYER FOR RELIEF WHEREFORE. and for each false record or statement that Defendant made. Defendant. is liable to the United States for treble damages under the FCA.. as follows: (a) that the United States be awarded damages in the amount of three times the damages sustained by the United States because of the false claims alleged within this Complaint. used. or caused to be made or used that was material to a false or fraudulent claim. By virtue of the false or fraudulent claims presented or caused to be presented by the Defendants. provides. which fraudulent scheme commenced upon the inception of ARROW-MED on January 23. as the Federal False Claims Act.C. plus a civil penalty of $5. DEMAND FOR JURY TRIAL Pursuant to Rule 38 of the Federal Rules of Civil Procedure. Darrell Stephen Mcintosh prays that the Court enter judgment against the Defendant.500 to $11.Page ID#: 20 104.S. 105. Relator hereby demands a trial by jury. 19 . (b) that civil penalties of $11. The claims relevant to this Count include all claims within the fraudulent scheme of the Defendant. in an amount to be determined at trial.

PSC 1050 Monarch Street.com Mark A. and (e) that this Court award such other and further relief as it deems proper. Ni allingford.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 21 of 22 . costs.Page ID#: 21 (c) that attorneys' fees. Esq. (d) that the Relator be awarded the maximum amount allowed to it pursuant to the False Claims Act. Wohlander.O. Suite 100 Lexington. Kentucky 40513 Telephone: (859) 219-0066 nick@wallingfordlaw. PSC P. Esq. Kentucky 40591 Telephone: (859) 361-5604 CO-COUNSEL FOR RELATOR 20 . WALLINGFORD LAW. and expenses that the Relator necessarily incurred in bringing and pressing this case be awarded. Box 910483 Lexington. WOHLANDER LAW OFFICE.

40507-1671 {Via Hand Delivery] 21 .Page ID#: 22 CERTIFICATE OF SERVICE The undersigned hereby certifies that a copy of the foregoing Qui Tam Complaint filed under seal pursuant to 31 U.Case: 5:15-cv-00105-JMH Doc #: 1 Filed: 04/24/15 Page: 22 of 22 . Kentucky.C.C.S. Harvey United States Attorney for the Eastern District of Kentucky 260 West Vine Street Suite 300 Lexington.W. N. D. Kerry B. 20530 /Via Federal Express] Hon. Washington. § 3730 was sent to the following: Hon. Eric Holder Attorney General of the United States Department of Justice 10th & Constitution Avenue.

00 --------------------------------- CHECK Check/Money Order Num: 9503 Amt Tendered: $400.00 Total Tendered: 400.Page ID#: 23 Court Name: US DISTRICT COURT EOKY Division: 5 Receipt Number: 5017691 Cashier ID: lcapezzu Transaction Date: 04/24/2015 Payer Name: Wallingford Law --------------------------------CIVIL FILING FEE For: Wallingford Law Case/Party: D-KYE-5-15-CV-000105-001 Amount: $400.00 --------------------------------Tot a1 Due: 1400.00 .Case: 5:15-cv-00105-JMH Doc #: 1-1 Filed: 04/24/15 Page: 1 of 1 .00 Change Amt: 0.

Hood Judge Code : 4311 Assigned on 04/24/2015 ... 4/24/2015 9:02 AM .pl Case: 5:15-cv-00105-JMH Doc #: 1-2 Filed: 04/24/15 Page: 1 of 1 .S. District Court Eastern District of Kentucky DCN Site 1 of 1 http://156.. Case number 5:15-CV-105 Assigned : Senior Judge Joseph M.125..U.6.194/cgi-bin/CaseAssign/CVCA...Page ID#: 24 .