- Office of Attorney General Maura Healey
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Emalie Gainey
Boston — A Somerville-based ambulance services provider has been sued for allegedly overbilling the state’s Medicaid program (MassHealth) for more than $600,000 in ambulance services that reflected a higher level of care than was actually provided, Attorney General Maura Healey announced today.
The complaint against Cataldo Ambulance Service, Inc. (Cataldo), filed on Thursday in Suffolk Superior Court, alleges that from 2005 to November 2015, Cataldo billed MassHealth for Emergency Advanced Life Support (ALS) services when, in fact, the patient’s condition at the scene only required, and the patient only received, Emergency Basic Life Support (BLS) services. Cataldo provides a variety of transportation services, including emergency ambulance services, throughout the Greater Boston area.
MassHealth reimburses ambulance providers at a greater rate for ALS codes than BLS codes. The AG’s Office alleges that over 40 percent of Cataldo’s submissions at the Emergency ALS Level 1 rate were false and should have been billed at the lower and less costly BLS level.
According to the complaint, Cataldo’s inappropriate billing practices persisted despite being notified that, in many instances, the patient’s condition and the services rendered were insufficient to justify billing at an ALS level. Cataldo also allegedly ignored concerns raised by its own employees, as well as other insurance payors, that claims for ALS services were submitted when documentation by Cataldo’s responding personnel clearly indicated the patient only needed and received BLS care.
The complaint seeks civil penalties, restitution and other compensation as the result of the AG’s allegations.
MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.
This case is being handled by Assistant Attorneys General David Scheffler and Casey Groff and Investigators Scott Grannemann and Nan Browne, all of AG Healey’s Medicaid Fraud Division, with assistance from Assistant Attorney General Diane Barry of AG Healey’s Executive Bureau. This matter was initiated after a referral from the Insurance Fraud Bureau and Federal Bureau of Investigation.
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