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Family Physician
Family Physician, Doctor (MD)
Category: Health
Satisfied Customers: 12816
Experience:  Emergency Medicine and Family Practice for over 26 years
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I am a worker at a Nursing Home, there is a patient that

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I am a worker at a Nursing Home, there is a patient that goes to and from dialysis treatments 3 times a week, the patient can sit, stand and scoot around in a wheelchair under her own power. She can clearly ride in a w/c as she does up and down the halls. If the non-contracted ambulance company wants to transport her by ambulance and commit helath care fraud can the administrator of the nursing home be held liable for conspiracy charges or some sort of criminal complaint if he/she allows this?
This is in referance to Health Care Fraud. Thank you.
Submitted: 7 years ago.
Category: Health
Expert:  Anthony Bray, MD replied 7 years ago.

Hello!

What is the alternative transportation of the patient???

If there is a reasonable alternative that is cheaper then of course this should be taken. If not then it is fatal to deny the patient dialysis. There do occur ridiculous seeming situations that come down to no alternative. If the patient has no resources other than medicare and medicare don't pay for a taxi then who is at fault???

Interesting the dilemmas....

Further questions/comments/discussion are welcome. Best regards,

Anthony Bray MD

Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10341
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and 3 other Health Specialists are ready to help you
Customer: replied 7 years ago.

There is another ambulance service that use to transport her in a wheelchair(the same way she moves around in the nursing home) also this patient rides in cars....Medicare says if the patient can safely be transported by other means other than that of an ambulance than those means should be utilized. So when this ambulance company takes her by ambulance they are commiting medicare fraud. My question is can the nursing home be held accountable for letting this occur?

Customer: replied 7 years ago.
Relist: Inaccurate answer.
Expert:  Family Physician replied 7 years ago.
As a physician, I do believe that the nursing home could become involved in this case, since clearly the patient does not meed medical necessity guidelines for ambulance transportation. The patient's needs can be met by a private vehicle or wheelchair van.

Any action on the part of the skilled nursing facility to assist in the procurement or billing for medically unnecessary services does place the SNF at risk. Personally, if I were the Medical Director of such a facility I would NOT allow such an arrangement.

HOWEVER, this is more of a legal issue, and I would suggest that an attorney review the case. I have asked the moderators to transfer this question to the legal section.
Family Physician, Doctor (MD)
Category: Health
Satisfied Customers: 12816
Experience: Emergency Medicine and Family Practice for over 26 years
Family Physician and 3 other Health Specialists are ready to help you