Whistleblower case: big settlement re Houston hospital fraud

You play ball with us, we’ll play ball with you.

That is one way to quickly and simply explain the relationship that several Houston-area hospitals allegedly had with multiple ambulance companies across the metro in recent years, say federal prosecutors.

More specifically, contend officials with the U.S. Department of Justice, area hospitals affiliated with a large Nashville-based company routinely pressured ambulance operators to charge notably low rates to transport patients to care centers. In exchange for being duly cooperative, those companies were included on a short list of preferred providers for more optimal patient rides in other instances.

That arrangement was widely known, say whistleblowers. An advocate for one of them states that ambulance companies wanting to survive in Houston “had to play the game and provide free and discounted services … to get the lucrative government business.”

Reportedly, invoices for ambulance rides were as low as $25 in some cases.

Although the Tennessee company settled a civil case with the DOJ just last week, agreeing to pay $8.6 million in fines and penalties, there is no expressed unanimity among all prosecutors concerning hospital officials’ bad faith in the matter.

Although one government attorney called the arrangement so egregious that “it didn’t pass the laugh test,” another stated that it was not unequivocally clear that facility actors were aware they were breaking any laws.

As noted in one article discussing the case and settlement, the matter serves to remind that the Houston area “continues to be one of the nation’s focal points for widespread Medicare and Medicaid abuse.”