More on Compliance & Legal

Ambulance company owner, brother sentenced in $6 million healthcare fraud case

The pair admitted they submitted approximately $6 million in false and fraudulent claims to Medicare, Medicaid and Tricare.

Jeff Lagasse, Associate Editor

Two brothers have been sentenced to more than four years in federal prison for their convictions of conspiracy to commit healthcare fraud, healthcare fraud and money laundering, according to the U.S. Attorney's Office of the Southern District of Texas. Kevin Olufemi Davies, 29, and his brother Melvin Olusola Davies, 28, pleaded guilty on Dec. 9, 2016.

The brothers owned and operated KMD Healthcare Services from their home in a gated townhouse community in Houston. As part of their guilty pleas, the pair admitted they submitted approximately $6 million in false and fraudulent claims to Medicare, Medicaid and Tricare, another government health program, for ambulance services that were not provided.

The brothers admitted they transported Medicare beneficiaries with only one of the two required EMTs, and in vans instead of ambulances. They also admitted they paid a Houston physician $500 for certificates of medical necessity and paid some of the Medicare beneficiaries to ride in the vans.

Medicare, Medicaid and Tricare only pay for medically necessary ambulance services in vehicles designed and equipped to respond to medical emergencies, and for patients who cannot be safely transported by any other means. Medicare also requires that two people staff the ambulance transports, including at least one licensed EMT.

[Also: New York doctors, clinic staff indicted in alleged 'pill mill' Medicare fraud ring that funneled millions of narcotics to black market]

On Monday, U.S. District Judge Lynn Hughes ordered Kevin Davies to serve a 57-month sentence, while his brother received 63 months in federal prison. Both will also be required to serve three years of supervised release following completion of the prison term. They were further ordered to pay more than $2.3 million in restitution.

In handing down the sentence, Judge Hughes said that stealing from taxpayers was not acceptable, and that probation was not an option for the brothers' conduct.

According to the plea agreements, the EMTs working for the defendants wrote up ambulance "run sheets" even though the Medicare beneficiaries did not travel by ambulance and did not need ambulance services. Those transported were not bed-bound, could walk and routinely used non-ambulance transport in their daily activities. One patient walked to her own therapy session, but KMD billed Medicare $51,952 for her ambulance transportation.

In total, KMD billed Medicare, Medicaid and Tricare approximately $6,293,108 in false and fraudulent claims for ambulance services that were not provided and not medically necessary. They received at least $2,201,137 from Medicare, $219,924 from Medicaid and about $16,735 from Tricare as payment for those claims.

The brothers have been in federal custody since their arrest on May 25, 2016. They have both forfeited vehicles they bought with the fraudulent proceeds, including a 2010 Porsche Panamera and a 2012 Mercedes Benz CLS.

Twitter: @JELagasse