A.G. Schneiderman Announces $173K Settlement With Wny Transportation Provider To Resolve Allegations Of Falsely Billing Medicaid

News from Attorney General Eric T. Schneiderman

September 26, 2016

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Investigation Found First Call, Inc. Billed Medicaid For Services Billed As Rendered By Unqualified Drivers Without Required Documentation; New York To Recover $173K In Restitution And Damages 

Schneiderman: We Will Continue Working To Root Out Medicaid Fraud And Hold Those Responsible Accountable

BUFFALO – Attorney General Eric T. Schneiderman announced today that his office has entered into a settlement agreement with First Call, Inc., to resolve allegations that it billed Medicaid for transportation services provided by unqualified drivers and without required documentation. 

“When providers bill and receive Medicaid payment by submitting claims reflecting services performed by unqualified providers and without required documentation, New York tax dollars are spent on services which are ineligible for such payment,” said Attorney General Schneiderman. “My office will continue working to investigate and address fraud alleged by whistleblowers in order to preserve the integrity of the Medicaid program and ensure that recipients receive quality services; and we will ensure that those responsible are held accountable.”

The Attorney General’s investigation determined that in 2009, after a Department of Motor Vehicles audit found that certain of the company’s drivers were unqualified under Article 19-A of the Vehicle and Traffic Law, First Call submitted and received payment on Medicaid claims for transportation services which identified such unqualified drivers as having provided the claimed services. In addition, the Attorney General found that for transportation services claimed to have been provided from June 1, 2007 through September 24, 2009, the company failed to maintain contemporaneous records demonstrating their right to receive payment in violation of Medicaid billing rules. The investigation settled False Claims Act allegations that are identified in the settlement agreement, pursuant to a qui tam lawsuit filed by whistleblower Thomas D. Ayers asserting claims under the New York False Claims Act.

As a result of the settlement, the company will pay New York State $173,650.83 in restitution and damages pursuant to the New York False Claims Act. 

Attorney General Schneiderman thanks the New York State Department of Motor Vehicles for their assistance with his investigation.

The Attorney General’s Medicaid Fraud Control Unit (MFCU) investigation was conducted by Supervising Investigator James Zablonski and Auditor-Investigator Sean McShea.  The Regional Chief Auditor is Frank Zeffiro. The case was handled by Special Assistant Attorney General Gary Baldauf, who is the Director of the Buffalo Regional MFCU Office.  Catherine Wagner is the MFCU Chief of Criminal Investigations-Upstate. William Falk is the MFCU Deputy Chief Investigator-Upstate. The Medicaid Fraud Control Unit is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. The Division of Criminal Justice is led by Executive Deputy Attorney General Kelly Donovan.