IN THE UNITED STATES DISTRICT COURT FOR THE ...wboc.images.worldnow.com/library/f3941f55-295c-4236-8f76...Qui tam relator Bryan Arvey (“Relator” or “Arvey”), by his attorneys,

CONFIDENTIAL AND UNDER SEAL – QUI TAM COMPLAINT

Anonymous v. Anonymous

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF MARYLAND

Baltimore Division

ANONYMOUS

Plaintiff,

v.

ANONYMOUS

Defendant.

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Case No. ___________________

COMPLAINT FOR VIOLATIONS OF

THE FALSE CLAIMS ACT, 31 U.S.C.

§§ 3729, et seq.

FILED UNDER SEAL

JURY TRIAL DEMANDED

Case 1:13-cv-01554-RDB Document 12 Filed 07/31/15 Page 1 of 19


United States ex rel. Arvey v. Hart to Heart Transportation Services, Inc. et. al.

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Baltimore Division

UNITED STATES OF AMERICA, ex rel.

BRYAN ARVEY

31895 Old Ocean City Road

Salisbury, Wicomico County, MD 21801

Plaintiff,

v.

HART TO HEART TRANSPORTATION

SERVICES, INC.

355 Granary Road, Suite A

Forest Hill, Harford County, MD 21050

EMS BILLING SOLUTIONS, INC.

355 Granary Road


PENINSULA REGIONAL MEDICAL

CENTER

(Susan McDonald – Registered Agent)

100 East Carroll Street

Salisbury, MD 21801

JOHN SKIDMORE

209 Holy Cross Road

Street, Harford County, MD 21154

TERRY SKIDMORE

209 Holy Cross Road


RICHARD SKIDMORE

45 Gomer Court

Elkton, Cecil County, MD 21921

Defendants.

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Case No. RDB-13-1554

FIRST AMENDED COMPLAINT FOR

VIOLATIONS OF THE FALSE CLAIMS

ACT, 31 U.S.C. §§ 3729, et seq.

FILED UNDER SEAL

JURY TRIAL DEMANDED




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INTRODUCTION

1. Qui tam relator Bryan Arvey (“Relator” or “Arvey”), by his attorneys, individually and

on behalf of the United States of America, files this complaint against Hart to Heart

Transportation Services, Inc. (“HHTS”), EMS Billing Solutions, Inc. (“EMS”),

Peninsula Regional Medical Center (PMRC), John Skidmore, Terry Skidmore, and

Richard Skidmore (collectively “Defendants”) to recover damages, penalties, and

attorneys’ fees for violations of the federal False Claims Act, 31 U.S.C. §§ 3729 et seq.,

(“FCA” or “False Claims Act”).

2. John and Terry Skidmore are the owners and operators of both HHTS and EMS and are

the individuals responsible for overseeing each company.

3. Defendant HHTS is a Maryland corporation in the business of providing commercial

ambulance and other healthcare-related transportation operations services.

4. Defendant EMS is a Maryland corporation in the business of providing claims processing

and billing services. HHTS is believed to be EMS’s only client.

5. Defendant PRMC is a Maryland non-profit hospital, providing a full range of medical

services.

6. Relator Arvey is a former ambulance driver for HHTS.

7. Medicare Part B covers eighty percent (80%) of a beneficiary’s approved ambulance cost

if transportation by ambulance is a “medical necessity.” Medical necessity is established

when “the patient’s condition is such that the use of any other method of transportation is

contraindicated.”




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8. Defendant HHTS required Relator Arvey and other ambulance drivers or emergency

medical technicians (EMTs) to falsify their narratives and use inaccurate billing codes to

reflect that ambulance transport was a necessity when such transportation was, in fact,

not a necessity.

9. PRMC staff acquiesced in and facilitated the false narratives by placing patients who

were not bed ridden in their beds on the instruction of HHTS, so that EMT’s could justify

transporting them by stretcher and ambulance.

10. Requiring EMTs to falsify their narratives allows HHTS to submit claims to EMS, which

in turn, remits the claims to Medicare for payment that would otherwise need to be

collected from the individual patient.

11. In reviewing claims submitted by HHTS, EMS determines which claims are likely to be

accepted by Medicare and which will be rejected. EMS returns to HHTS those claims

that are likely to be rejected by Medicare and identifies the “corrections” necessary to

ensure acceptance by Medicare.

12. Defendant John Skidmore established and operated HHTS and EMS with the intent to

defraud the United States through the submission of false Medicare claims.

13. Defendant Richard Skidmore is employed as the Vice President of Operations and Safety

to HHTS and explicitly instructed Relator and other HHTS employees to create false

records in support of fraudulent the company’s fraudulent Medicare claims.

14. In violation of 31 U.S.C. §§ 3729(a)(1)(A), Defendants submitted or caused to be

submitted false Medicare claims when they billed Medicare for ambulance transportation

that they knew was not medically necessary.




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15. In violation of 31 U.S.C. §§ 3729(a)(1)(B), Defendants knowingly caused the creation of

false records in support of those false claims to meet the documentation requirements

imposed upon them by the Medicare program.

16. In violation of 31 U.S.C. §§ 3729(a)(1)(C), Defendants entered into a conspiracy to

defraud the United States by submitting false or fraudulent Medicare claims and by

creating false records in support of those false or fraudulent Medicare claims.

17. Relator estimates that approximately half of the 50,000 ambulance pick-ups he observed

during his time employed by defendants were not medically necessary.

18. Focusing only on the pick-ups by Relator, himself, could result in the submission of false

Medicare claims in the millions of dollars.

19. Relator and other current and former ambulance drivers and EMTs confirm that the

practice of submitting false reports is “very common” and “happens all the time.” Thus,

it is reasonable to assume that drivers other than Relator are forced to submit false

reports.

20. HHTS has been in business for nearly seventeen (19) years and, at present, provides

approximately 69,000 transports per year relying on eighty road units. Depending upon

the prevalence and duration of the falsely submitted claims, the damages to the United

States could be in the tens of millions of dollars.

21. To Relator’s knowledge, Defendants’ fraud remains ongoing through to the present.

JURISDICTION AND VENUE

22. This Court has subject matter jurisdiction over this action under 28 U.S.C. § 1331 and 31

U.S.C. § 3732(a).




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23. This Court has personal jurisdiction over Defendants pursuant to 31 U.S.C. § 3732(a)

because the Defendants transact business in this judicial district.

24. Venue is proper in this Court under 28 U.S.C. §1391(c) and 1395(a), and 31 U.S.C. §

3732(a) because the complained of illegal acts occurred within this judicial district, the

Defendant is a resident of this district, and because the Defendant transacts business

within this judicial district.

PARTIES

25. Relator Arvey is a thirty (30) year old male and resident of Wicomico County, Maryland.

26. Defendant HHTS is a Maryland Corporation, headquartered in Harford County. HHTS is

in the business of providing commercial ambulance and other healthcare-related

transportation operation services.

27. HHTS is a licensed provider for Medicare Part B services.

28. Defendant EMS is a Maryland Corporation, headquartered at the same physical address

as Defendant HHTS. EMS is in the business of claims processing for medical

transportation companies.

29. Defendant PRMC is a hospital with a full range of medical services, including 292 acute

care beds.

30. Relator made the vast majority of his pick-ups from PRMC.

31. Defendant John Skidmore is the owner, operator, and founder of both HHTS and EMS.

32. Defendant Richard Skidmore is the the Vice President of Operations and Safety at HHTS

and was Relator’s supervisor.

33. HHTS hired Arvey as a driver in the summer of 2010.




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34. At all times material to this complaint, Arvey was employed by Defendant HHTS

operating out of the company’s Salisbury, Maryland location.

35. Arvey has firsthand knowledge of Defendants HHTS’s, EMS’s, and Richard Skidmore’s

fraudulent business practices.

36. Defendant HHTS terminated Arvey’s employment in February 2013.

FACTUAL ALLEGATIONS

Founding Hart To Heart Transportation Services and EMS Billing Solutions

37. Defendant John Skidmore founded HHTS in 1996 to provide ambulance and other

healthcare-related transportation services to patients.

38. HHTS employs more than 350 people and has eighty (80) vehicles in its transportation

fleet.

39. HHTS is licensed to provide emergency medical services, wheelchair services, and sedan

services in Maryland, Delaware, Pennsylvania, and New Jersey.

40. HHTS runs approximately 69,000 transports annually and ran 62,000 transports in 2012.

Defendant’s Salisbury, Maryland location, out of which Relator worked, runs

approximately 19,500 transports annually.

41. HHTS is a licensed provider for Medicare Part B and submits a high volume of Medicare

claims for payment.

42. Approximately six years after he founded HHTS, John Skidmore founded Defendant

EMS. John Skidmore remains the owner of each company.

43. EMS is responsible for processing claims submitted by HHTS and remitting those claims

to the United States for payment through the Medicare program.




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Relator’s Job Duties And Case Reports

44. HHTS hired Relator during the summer of 2010.

45. Relator’s duties consisted of driving various healthcare-related transport vehicles –

including wheelchair transports, the cancer bus, and the critical care unit – and assisting

paramedics with the administration of emergency medical care.

46. For each completed transport, the assigned EMT is responsible for completing a case

report.

47. Completing a case report requires the EMT to identify the appropriate billing code and to

draft a narrative describing the transportation.

HHTS’s Billing Practices

48. Once an EMT completes a case report, that report is submitted to the corporate office.

49. Medical Director Scott Steinmetz, M.D., reviews the case reports and forwards them to

defendant EMS.

50. EMS analyzes the case report and, for cases to be billed to the Centers for Medicare and

Medicaid Services (CMS), ensures that the case report meets all of the requirements for

reimbursement.

51. If the case report meets all necessary requirements, EMS submits the claim to CMS for

payment.

HHTS Directs Relator And Other Employees To Falsify Case Report Narratives

52. If the case report does not meet all of the necessary requirements, EMS returns the case

report to HHTS.




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53. Included within its communications to HHTS, EMS identifies the deficiencies that would

prevent the claim from being paid by Medicare under CMS regulations.

54. Defendant Richard Skidmore or, on occasion, Lisa Sievers, Risk & Safety Director, sends

the returned case report to the driver with instructions to make the necessary

“corrections” that will, per CMS regulations, make the claim payable by Medicare.

55. Once the case reports were “corrected,” HHTS re-sent the claims to EMS which would

then remit the revised claims for payment through Medicare.

56. As a result of HHTS forcing its personnel to falsify their reports, the company requires

that its drivers and Emergency Medical Technicians (EMTs) use stretchers to transport

patients, even if stretchers were not required.

57. For a typical transport, EMTs would arrive at PRMC or other hospitals and instruct the

hospital staff to place the patient in a stretcher, even if the patient did not need one.

58. The EMT would then have the hospital staff transport the patient, who was now on the

stretcher, to the ambulance vehicle.

59. On one or more occasions, Relator called the HHTS dispatcher to report that a patient

was ambulatory and did not need a stretcher. Dispatch responded by instructing Relator

to “take the patient by stretcher anyway,” or words to that effect.

60. HHTS instructed EMTs that if they saw patients walking, they should leave the room and

ask the hospital staff to put the patient into his or her bed.

61. Once the hospital staff put the patient back in bed, the EMTs and hospital staff would

load the patient onto a stretcher and take them to the ambulance.




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62. By forcing its employees to use a stretcher during transportation, HHTS could more

easily falsify its documentation to make it appear as though transportation by ambulance

was a medical necessity.

63. If a patient absolutely refused to use the stretcher, Richard Skidmore instructed Relator

and other drivers to falsify their narratives with statements such as “[T]he patient could

not stand, walk or pivot,” or that “[T]he patient could only ambulate with ‘maximum

assistance’ where two HHTS employees were needed to move the patient around.”

64. Such statements made it seem as though transportation by ambulance was a medical

necessity, thereby increasing the chances that the claim would be paid through Medicare.

65. Relator questioned more senior EMTs and paramedics about the practice of falsifying

narratives, but his colleagues told him that he should follow Richard Skidmore’s

instructions to write false narratives.

66. Richard Skidmore threatened Relator and other employees, stating that a failure to

“correct” their case reports in this manner would result in suspension or termination.

67. Richard Skidmore’s threats were made orally and through e-mail.

68. During a period in or around September 2012 when Relator assisted with office duties,

Relator learned that Richard Skidmore instructed managers to “correct” case reports

themselves by entering an employee’s social security number to access the report within

the system.

HHTS Directs Relator And Other Employees To Falsify Billing Codes




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69. When HHTS hired Relator in the summer of 2010, the company allowed its drivers to

select from approximately fifty (50) billing codes, some of which indicated that transport

by ambulance was not a medical necessity.

70. Within a few weeks of Relator starting at HHTS, the company eliminated all but two (2)

billing codes.

71. The remaining two billing codes supported claims to Medicare because they indicated

that transportation by ambulance was a medical necessity.

72. Thus, HHTS required Relator and other employees to choose only from billing codes that

defined a particular trip as a medical necessity, even if the trip did not, in fact, meet the

requirements of medical necessity.

COUNT I

Defendants Knowingly Presented or Caused to be Presented False or Fraudulent Claims

for Payment to the United States in Violation of the False Claims Act

31 U.S.C. § 3729(a)(1)(A)

73. Arvey realleges and incorporates the allegations set forth above as though fully alleged

therein.

74. By virtue of the acts described above, Defendants knowingly presented or caused to be

presented to the United States Government false or fraudulent claims for payment or

approval under the federally-funded Medicare programs in violation of 31 U.S.C. §

3729(a)(1).

75. Medicare Part B covers eighty percent (80%) of a beneficiary’s approved ambulance

cost after the yearly deductible is paid.




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76. To be covered, ambulance transportation must be reasonable and medically necessary.

Medical necessity exists in cases where no means of transportation other than an

ambulance can be used without endangering the patient’s health.

77. Defendant HHTS provided transportation via ambulances that was not medically

necessary for thousands of patients.

78. Defendant HHTS caused false claims to be presented to the United States when it

provided these claims to EMS for processing and remittance to CMS.

79. When Defendant EMS received a Medicare claim and that did not meet CMS regulations,

it identified the deficiencies in the claim and sent the case report back to HHTS for

“correcting.”

80. HHTS, per instructions from EMS, “corrected” the claims and re-sent the case report and

false claims to EMS for processing and remittance to the government.

81. EMS, having already seen the original claims, knew or reasonably should have known

that the “corrected” claims were false when it presented them to CMS for payment.

82. Defendant PRMC acquiesced in and facilitated the medically unnecessary transport of

patients by stretcher and ambulance.

83. John Skidmore, as founder, owner, and operator of both HHTS and EMS, had knowledge

of and directed the false claim submissions and established the companies with the

purpose of engaging in fraudulent conduct.

84. Terry Skidmore, as owner and operator of HHTS, had knowledge of and directed the

false claim submissions and established the companies with the purpose of engaging in

fraudulent conduct.




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85. By reasons of the acts and conduct of the HHTS and EMS in violation of 31 U.S.C. §

3729(a)(1)(A), the United States has suffered actual damages, including the total amounts

paid in response to all such false or fraudulent claims for payment. In addition, the

United States is entitled to recover civil money penalties, and other monetary relief as

deemed appropriate.

COUNT II

Defendants Knowingly Made and Used or Caused to Be Made And Used A False Record

Material To A Fraudulent Claim in Violation of the False Claims Act

31 U.S.C. § 3729(a)(1)(B)


therein.

87. By virtue of the acts described above, Defendants knowingly caused the creation of false

documents and records in support of their false or fraudulent claims for payment or

approval under the federally-funded Medicare programs in violation of 31 U.S.C. §

3729(a)(1)(B).

88. Defendant HHTS created false records in at least three ways:

a. HHTS forced its employees to use billing codes that indicate ambulance service

was a medical necessity when such service, in fact, was not a medical necessity.

b. HHTS forced its employees and PRMC employees to use stretchers when

transporting patients, even when the use of such equipment was not necessary.

HHTS then created false records when it relied on the use of a stretcher as

evidence of ambulance transportation being a medical necessity.

c. HHTS falsely represented that many of its patients were non-ambulatory and

required maximum assistance to board the ambulance prior to transport. Relying




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on these false representations enabled HHTS to create fraudulent case reports to

accompany its false claims for payment to CMS.

89. Defendant EMS caused false records to be created by advising HHTS how to “correct”

claims that would not pass the criteria set forth by CMS for payment.

90. John Skidmore, as founder, owner, and operator of both HHTS and EMS, had knowledge

of and directed the creation of false records and established the companies with the

purpose of engaging in fraudulent conduct.

91. Richard Skidmore, as Vice President of Operations and Safety, directed Relator and other

HHTS employees to create false records in support of the company’s fraudulent Medicare

claims under threat of suspension or termination.

92. By reasons of the acts and conduct of the HHTS and EMS in violation of 31 U.S.C. §

3729(a)(1)(B), the United States has suffered actual damages, including the total amounts

paid in response to all such false or fraudulent claims for payment. In addition, the

United States is entitled to recover civil money penalties, and other monetary relief as

deemed appropriate.

COUNT III

Defendants Conspired To Present False or Fraudulent Claims For Payment to the

United States in Violation of the False Claims Act

31 U.S.C. § 3729(a)(1)(C)


therein.

94. The Federal False Claims Act, 31 U.S.C. § 3729(a)(1)(C) provides for liability against

person who conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or

(G).”




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95. In violation of 31 U.S.C. § 3729(a)(1)(C), by the foregoing acts and omissions,

Defendants conspired to violate 31 U.S.C. § 3729(a)(1)(A) and 3729(a)(1)(B).

96. John Skidmore is the common owner and founder of both Defendant HHTS and

Defendant EMS.

97. By virtue of the acts described above, Defendants HHTS, PRMC, and EMS entered into a

conspiracy to defraud the United States by presenting or causing to be presented false or

fraudulent Medicare claims for payment and by making or causing to be made false

records material to their fraudulent claims.

98. Defendant HHTS provided ambulance and other healthcare-related transportation

services that it knew was non-compliant with CMS regulations for Medicare

reimbursement. PRMC acquiesced in and facilitated medically unnecessary transport of

its patients by stretcher and ambulance. EMS advised HHTS on how to describe its

services in such a way that would increase the likelihood of payment by the United States

for HHTS’s non-compliant services.

99. By the foregoing acts and omissions, Defendants took action in furtherance of their

conspiracy when HHTS resubmitted “corrected” claims and case reports to EMS, which,

in turn, remitted the claims for payment to CMS.

100. Defendants’ were aware of the falsity of the claims and invoices submitted to the

government.

101. Defendants John, Terry, and Richard Skidmore directed HHTS and CMS to

submit false claims and create fraudulent records to support those false claims.





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888 17th Street, N.W., Suite 900

Washington, D.C. 20006

(202) 261 – 2810

(202) 261 – 2835 (facsimile)

[email protected]

[email protected]

Counsel for Plaintiff-Relator




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JURY DEMAND

Pursuant to Rule 38 of the Federal Rules of Civil Procedure, Bryan Arvey demands a jury trial.




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CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was served via

certified mail, on this 28th day of July 2015, upon:

Loretta Lynch, Esq.

Attorney General of the United States

Office of the Attorney General, Civil Division

U.S. Department of Justice

950 Pennsylvania Avenue, NW

Washington, DC 20530-0001

Rod J. Rosenstein, Esq.

United States Attorney

District of Maryland

36 South Charles Street, 4th Floor

Baltimore, Maryland 21201

Roann Nichols, Esq.

Assistant U.S. Attorney


36 S. Charles Street, 4th

Floor

Baltimore, MD 21201

/s

David L. Scher



Anonymous v. Anonymous



Baltimore Division

ANONYMOUS

Plaintiff,

v.

ANONYMOUS

Defendant.

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Case No. ___________________

COMPLAINT FOR VIOLATIONS OF

THE FALSE CLAIMS ACT, 31 U.S.C.

§§ 3729, et seq.

FILED UNDER SEAL

JURY TRIAL DEMANDED

Case 1:13-cv-01554-RDB Document 12-1 Filed 07/31/15 Page 1 of 19



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Baltimore Division

UNITED STATES OF AMERICA, ex rel.

BRYAN ARVEY

31895 Old Ocean City Road

Salisbury, Wicomico County, MD 21801

Plaintiff,

v.

HART TO HEART TRANSPORTATION

SERVICES, INC.

355 Granary Road, Suite A


EMS BILLING SOLUTIONS, INC.

355 Granary Road


PENINSULA REGIONAL MEDICAL

CENTER

(Susan McDonald – Registered Agent)

100 East Carroll Street

Salisbury, MD 21801

JOHN SKIDMORE

209 Holy Cross Road


TERRY SKIDMORE

209 Holy Cross Road


RICHARD SKIDMORE

45 Gomer Court

Elkton, Cecil County, MD 21921

Defendants.

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Case No. RDB-13-1554

FIRST AMENDED COMPLAINT FOR

VIOLATIONS OF THE FALSE CLAIMS

ACT, 31 U.S.C. §§ 3729, et seq.

FILED UNDER SEAL

JURY TRIAL DEMANDED




3

INTRODUCTION

1. Qui tam relator Bryan Arvey (“Relator” or “Arvey”), by his attorneys, individually and

on behalf of the United States of America, files this complaint against Hart to Heart

Transportation Services, Inc. (“HHTS”), EMS Billing Solutions, Inc. (“EMS”),

Peninsula Regional Medical Center (PMRC), John Skidmore, Terry Skidmore, and

Richard Skidmore (collectively “Defendants”) to recover damages, penalties, and

attorneys’ fees for violations of the federal False Claims Act, 31 U.S.C. §§ 3729 et seq.,

(“FCA” or “False Claims Act”).

2. John and Terry Skidmore are the owners and operators of both HHTS and EMS and are

the individuals responsible for overseeing each company.

3. Defendant HHTS is a Maryland corporation in the business of providing commercial

ambulance and other healthcare-related transportation operations services.

4. Defendant EMS is a Maryland corporation in the business of providing claims processing

and billing services. HHTS is believed to be EMS’s only client.

4.5.Defendant PRMC is a Maryland non-profit hospital, providing a full range of medical

services.

5.6.Relator Arvey is a former ambulance driver for HHTS.

6.7.Medicare Part B covers eighty percent (80%) of a beneficiary’s approved ambulance cost

if transportation by ambulance is a “medical necessity.” Medical necessity is established

when “the patient’s condition is such that the use of any other method of transportation is

contraindicated.”




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8. Defendant HHTS required Relator Arvey and other ambulance drivers or emergency

medical technicians (EMTs) to falsify their narratives and use inaccurate billing codes to

reflect that ambulance transport was a necessity when such transportation was, in fact,

not a necessity.

7.9.PRMC staff acquiesced in and facilitated the false narratives by placing patients who

were not bed ridden in their beds on the instruction of HHTS, so that EMT’s could justify

transporting them by stretcher and ambulance.

8.10. Requiring EMTs to falsify their narratives allows HHTS to submit claims to

EMS, which in turn, remits the claims to Medicare for payment that would otherwise

need to be collected from the individual patient.

9.11. In reviewing claims submitted by HHTS, EMS determines which claims are likely

to be accepted by Medicare and which will be rejected. EMS returns to HHTS those

claims that are likely to be rejected by Medicare and identifies the “corrections”

necessary to ensure acceptance by Medicare.

10.12. Defendant John Skidmore established and operated HHTS and EMS with the

intent to defraud the United States through the submission of false Medicare claims.

11.13. Defendant Richard Skidmore is employed as the Vice President of Operations and

Safety to HHTS and explicitly instructed Relator and other HHTS employees to create

false records in support of fraudulent the company’s fraudulent Medicare claims.

12.14. In violation of 31 U.S.C. §§ 3729(a)(1)(A), Defendants submitted or caused to be

submitted false Medicare claims when they billed Medicare for ambulance transportation

that they knew was not medically necessary.




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13.15. In violation of 31 U.S.C. §§ 3729(a)(1)(B), Defendants knowingly caused the

creation of false records in support of those false claims to meet the documentation

requirements imposed upon them by the Medicare program.

14.16. In violation of 31 U.S.C. §§ 3729(a)(1)(C), Defendants entered into a conspiracy

to defraud the United States by submitting false or fraudulent Medicare claims and by

creating false records in support of those false or fraudulent Medicare claims.

15.17. Relator estimates that approximately half of the 50,000 ambulance pick-ups he

observed during his time employed by defendants were not medically necessary.

16.18. Focusing only on the pick-ups by Relator, himself, could result in the submission

of false Medicare claims in the millions of dollars.

17.19. Relator and other current and former ambulance drivers and EMTs confirm that

the practice of submitting false reports is “very common” and “happens all the time.”

Thus, it is reasonable to assume that drivers other than Relator are forced to submit false

reports.

18.20. HHTS has been in business for nearly seventeen (179) years and, at present,

provides approximately 69,000 transports per year relying on eighty road units.

Depending upon the prevalence and duration of the falsely submitted claims, the damages

to the United States could be in the tens of millions of dollars.

19.21. To Relator’s knowledge, Defendants’ fraud remains ongoing through to the

present.

JURISDICTION AND VENUE




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20.22. This Court has subject matter jurisdiction over this action under 28 U.S.C. § 1331

and 31 U.S.C. § 3732(a).

21.23. This Court has personal jurisdiction over Defendants pursuant to 31 U.S.C. §

3732(a) because the Defendants transact business in this judicial district.

22.24. Venue is proper in this Court under 28 U.S.C. §1391(c) and 1395(a), and 31

U.S.C. § 3732(a) because the complained of illegal acts occurred within this judicial

district, the Defendant is a resident of this district, and because the Defendant transacts

business within this judicial district.

PARTIES

23.25. Relator Arvey is a thirty (30) year old male and resident of Wicomico County,

Maryland.

24.26. Defendant HHTS is a Maryland Corporation, headquartered in Harford County.

HHTS is in the business of providing commercial ambulance and other healthcare-related

transportation operation services.

25.27. HHTS is a licensed provider for Medicare Part B services.

26.28. Defendant EMS is a Maryland Corporation, headquartered at the same physical

address as Defendant HHTS. EMS is in the business of claims processing for medical

transportation companies.

29. Defendant PRMC is a hospital with a full range of medical services, including 292 acute

care beds.

27.30. Relator made the vast majority of his pick-ups from PRMC.




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28.31. Defendant John Skidmore is the owner, operator, and founder of both HHTS and

EMS.

29.32. Defendant Richard Skidmore is the the Vice President of Operations and Safety at

HHTS and was Relator’s supervisor.

30.33. HHTS hired Arvey as a driver in the summer of 2010.

31.34. At all times material to this complaint, Arvey was employed by Defendant HHTS

operating out of the company’s Salisbury, Maryland location.

32.35. Arvey has firsthand knowledge of Defendants HHTS’s, EMS’s, and Richard

Skidmore’s fraudulent business practices.

33.36. Defendant HHTS terminated Arvey’s employment in February 2013.

FACTUAL ALLEGATIONS

Founding Hart To Heart Transportation Services and EMS Billing Solutions

34.37. Defendant John Skidmore founded HHTS in 1996 to provide ambulance and

other healthcare-related transportation services to patients.

35.38. HHTS employs more than 350 people and has eighty (80) vehicles in its

transportation fleet.

36.39. HHTS is licensed to provide emergency medical services, wheelchair services,

and sedan services in Maryland, Delaware, Pennsylvania, and New Jersey.

37.40. HHTS runs approximately 69,000 transports annually and ran 62,000 transports in

2012. Defendant’s Salisbury, Maryland location, out of which Relator worked, runs

approximately 19,500 transports annually.




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38.41. HHTS is a licensed provider for Medicare Part B and submits a high volume of

Medicare claims for payment.

39.42. Approximately six years after he founded HHTS, John Skidmore founded

Defendant EMS. John Skidmore remains the owner of each company.

40.43. EMS is responsible for processing claims submitted by HHTS and remitting those

claims to the United States for payment through the Medicare program.

Relator’s Job Duties And Case Reports

41.44. HHTS hired Relator during the summer of 2010.

42.45. Relator’s duties consisted of driving various healthcare-related transport vehicles

– including wheelchair transports, the cancer bus, and the critical care unit – and assisting

paramedics with the administration of emergency medical care.

43.46. For each completed transport, the assigned EMT is responsible for completing a

case report.

44.47. Completing a case report requires the EMT to identify the appropriate billing code

and to draft a narrative describing the transportation.

HHTS’s Billing Practices

45.48. Once an EMT completes a case report, that report is submitted to the corporate

office.

46.49. Medical Director Scott Steinmetz, M.D., reviews the case reports and forwards

them to defendant EMS.




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47.50. EMS analyzes the case report and, for cases to be billed to the Centers for

Medicare and Medicaid Services (CMS), ensures that the case report meets all of the

requirements for reimbursement.

48.51. If the case report meets all necessary requirements, EMS submits the claim to

CMS for payment.

HHTS Directs Relator And Other Employees To Falsify Case Report Narratives

49.52. If the case report does not meet all of the necessary requirements, EMS returns

the case report to HHTS.

50.53. Included within its communications to HHTS, EMS identifies the deficiencies

that would prevent the claim from being paid by Medicare under CMS regulations.

51.54. Defendant Richard Skidmore or, on occasion, Lisa Sievers, Risk & Safety

Director, sends the returned case report to the driver with instructions to make the

necessary “corrections” that will, per CMS regulations, make the claim payable by

Medicare.

52.55. Once the case reports were “corrected,” HHTS re-sent the claims to EMS which

would then remit the revised claims for payment through Medicare.

56. As a result of HHTS forcing its personnel to falsify their reports, the company requires

that its drivers and Emergency Medical Technicians (EMTs) use stretchers to transport

patients, even if stretchers were not required.

57. For a typical transport, EMTs would arrive at PRMC or other hospitals and instruct the

hospital staff to place the patient in a stretcher, even if the patient did not need one.




10

53.58. The EMT would then have the hospital staff transport the patient, who was now

on the stretcher, to the ambulance vehicle.

59. On one or more occasions, Relator called the HHTS dispatcher to report that a patient

was ambulatory and did not need a stretcher. Dispatch responded by instructing Relator

to “take the patient by stretcher anyway,” or words to that effect.

60. HHTS instructed EMTs that if they saw patients walking, they should leave the room and

ask the hospital staff to put the patient into his or her bed.

54.61. Once the hospital staff put the patient back in bed, the EMTs and hospital staff

would load the patient onto a stretcher and take them to the ambulance.

55.62. By forcing its employees to use a stretcher during transportation, HHTS could

more easily falsify its documentation to make it appear as though transportation by

ambulance was a medical necessity.

56.63. If a patient absolutely refused to use the stretcher, Richard Skidmore instructed

Relator and other drivers to falsify their narratives with statements such as “[T]he patient

could not stand, walk or pivot,” or that “[T]he patient could only ambulate with

‘maximum assistance’ where two HHTS employees were needed to move the patient

around.”

57.64. Such statements made it seem as though transportation by ambulance was a

medical necessity, thereby increasing the chances that the claim would be paid through

Medicare.




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58.65. Relator questioned more senior EMTs and paramedics about the practice of

falsifying narratives, but his colleagues told him that he should follow Richard

Skidmore’s instructions to write false narratives.

59.66. Richard Skidmore threatened Relator and other employees, stating that a failure to

“correct” their case reports in this manner would result in suspension or termination.

60.67. Richard Skidmore’s threats were made orally and through e-mail.

61.68. During a period in or around September 2012 when Relator assisted with office

duties, Relator learned that Richard Skidmore instructed managers to “correct” case

reports themselves by entering an employee’s social security number to access the report

within the system.

HHTS Directs Relator And Other Employees To Falsify Billing Codes

62.69. When HHTS hired Relator in the summer of 2010, the company allowed its

drivers to select from approximately fifty (50) billing codes, some of which indicated that

transport by ambulance was not a medical necessity.

63.70. Within a few weeks of Relator starting at HHTS, the company eliminated all but

two (2) billing codes.

64.71. The remaining two billing codes supported claims to Medicare because they

indicated that transportation by ambulance was a medical necessity.

65.72. Thus, HHTS required Relator and other employees to choose only from billing

codes that defined a particular trip as a medical necessity, even if the trip did not, in fact,

meet the requirements of medical necessity.

COUNT I

Defendants Knowingly Presented or Caused to be Presented False or Fraudulent Claims




12

for Payment to the United States in Violation of the False Claims Act

31 U.S.C. § 3729(a)(1)(A)

66.73. Arvey realleges and incorporates the allegations set forth above as though fully

alleged therein.

67.74. By virtue of the acts described above, Defendants knowingly presented or caused

to be presented to the United States Government false or fraudulent claims for payment

or approval under the federally-funded Medicare programs in violation of 31 U.S.C. §

3729(a)(1).

68.75. Medicare Part B covers eighty percent (80%) of a beneficiary’s approved

ambulance cost after the yearly deductible is paid.

69.76. To be covered, ambulance transportation must be reasonable and medically

necessary. Medical necessity exists in cases where no means of transportation other than

an ambulance can be used without endangering the patient’s health.

70.77. Defendant HHTS provided transportation via ambulances that was not medically

necessary for thousands of patients.

71.78. Defendant HHTS caused false claims to be presented to the United States when it

provided these claims to EMS for processing and remittance to CMS.

72.79. When Defendant EMS received a Medicare claim and that did not meet CMS

regulations, it identified the deficiencies in the claim and sent the case report back to

HHTS for “correcting.”

73.80. HHTS, per instructions from EMS, “corrected” the claims and re-sent the case

report and false claims to EMS for processing and remittance to the government.




13

81. EMS, having already seen the original claims, knew or reasonably should have known

that the “corrected” claims were false when it presented them to CMS for payment.

74.82. Defendant PRMC acquiesced in and facilitated the medically unnecessary

transport of patients by stretcher and ambulance.

75.83. John Skidmore, as founder, owner, and operator of both HHTS and EMS, had

knowledge of and directed the false claim submissions and established the companies

with the purpose of engaging in fraudulent conduct.

76.84. Terry Skidmore, as owner and operator of HHTS, had knowledge of and directed

the false claim submissions and established the companies with the purpose of engaging

in fraudulent conduct.

77.85. By reasons of the acts and conduct of the HHTS and EMS in violation of 31

U.S.C. § 3729(a)(1)(A), the United States has suffered actual damages, including the total

amounts paid in response to all such false or fraudulent claims for payment. In addition,

the United States is entitled to recover civil money penalties, and other monetary relief as

deemed appropriate.

COUNT II

Defendants Knowingly Made and Used or Caused to Be Made And Used A False Record

Material To A Fraudulent Claim in Violation of the False Claims Act

31 U.S.C. § 3729(a)(1)(B)


alleged therein.

79.87. By virtue of the acts described above, Defendants knowingly caused the creation

of false documents and records in support of their false or fraudulent claims for payment




14

or approval under the federally-funded Medicare programs in violation of 31 U.S.C. §

3729(a)(1)(B).

80.88. Defendant HHTS created false records in at least three ways:

a. HHTS forced its employees to use billing codes that indicate ambulance service

was a medical necessity when such service, in fact, was not a medical necessity.

b. HHTS forced its employees and PRMC employees to use stretchers when

transporting patients, even when the use of such equipment was not necessary.

HHTS then created false records when it relied on the use of a stretcher as

evidence of ambulance transportation being a medical necessity.

c. HHTS falsely represented that many of its patients were non-ambulatory and

required maximum assistance to board the ambulance prior to transport. Relying

on these false representations enabled HHTS to create fraudulent case reports to

accompany its false claims for payment to CMS.

81.89. Defendant EMS caused false records to be created by advising HHTS how to

“correct” claims that would not pass the criteria set forth by CMS for payment.

82.90. John Skidmore, as founder, owner, and operator of both HHTS and EMS, had

knowledge of and directed the creation of false records and established the companies

with the purpose of engaging in fraudulent conduct.

83.91. Richard Skidmore, as Vice President of Operations and Safety, directed Relator

and other HHTS employees to create false records in support of the company’s fraudulent

Medicare claims under threat of suspension or termination.




15

84.92. By reasons of the acts and conduct of the HHTS and EMS in violation of 31

U.S.C. § 3729(a)(1)(B), the United States has suffered actual damages, including the total

amounts paid in response to all such false or fraudulent claims for payment. In addition,

the United States is entitled to recover civil money penalties, and other monetary relief as

deemed appropriate.

COUNT III

Defendants Conspired To Present False or Fraudulent Claims For Payment to the

United States in Violation of the False Claims Act

31 U.S.C. § 3729(a)(1)(C)


alleged therein.

86.94. The Federal False Claims Act, 31 U.S.C. § 3729(a)(1)(C) provides for liability

against person who conspires to commit a violation of subparagraph (A), (B), (D), (E),

(F), or (G).”

87.95. In violation of 31 U.S.C. § 3729(a)(1)(C), by the foregoing acts and omissions,

Defendants conspired to violate 31 U.S.C. § 3729(a)(1)(A) and 3729(a)(1)(B).

88.96. John Skidmore is the common owner and founder of both Defendant HHTS and

Defendant EMS.

89.97. By virtue of the acts described above, Defendants HHTS, PRMC, and EMS

entered into a conspiracy to defraud the United States by presenting or causing to be

presented false or fraudulent Medicare claims for payment and by making or causing to

be made false records material to their fraudulent claims.

90.98. Defendant HHTS provided ambulance and other healthcare-related transportation

services that it knew was non-compliant with CMS regulations for Medicare




16

reimbursement. PRMC acquiesced in and facilitated medically unnecessary transport of

its patients by stretcher and ambulance. EMS advised HHTS on how to describe its

services in such a way that would increase the likelihood of payment by the United States

for HHTS’s non-compliant services.

91.99. By the foregoing acts and omissions, Defendants took action in furtherance of

their conspiracy when HHTS resubmitted “corrected” claims and case reports to EMS,

which, in turn, remitted the claims for payment to CMS.

92.100. Defendants’ were aware of the falsity of the claims and invoices submitted to the

government.

93.101. Defendants John, Terry, and Richard Skidmore directed HHTS and CMS to

submit false claims and create fraudulent records to support those false claims.

94.102. As a consequence of Defendants' violations of 31 U.S.C. § 3729 (a)(1)(C), the

United States has suffered substantial losses, and is entitled to treble damages under the

False Claims Act, to be determined at trial, plus a civil penalty of $5,500 to $11,000 for

each such false claim Defendants conspired to get paid or allowed.

PRAYER FOR RELIEF

WHEREFORE, the Relator Bryan Arvey, acting on behalf of and in the name of the United

States of America, and on her own behalf, prays that judgment be entered against Defendants for

violation of the False Claims Act as follows:

(a) In favor of the United States against the Defendants for treble damages to the federal

government from the submission of false claims, and the maximum civil penalties for

each violation of the False Claims Act;




17

(b) In favor of the Relator for the maximum amount pursuant to 31 U.S.C. § 3730(d) to

include reasonable expenses, attorney fees, and costs incurred by the Relator;

(c) For all costs of the False Claims Act civil action; and

(d) In favor of the Relator and the United States for further relief as this court deems just and

equitable.

Respectfully submitted,

_____________________________

R. Scott Oswald, DMD Bar No. 25391

David L. Scher, DMD Bar No. 17187

The Employment Law Group, P.C.

888 17th Street, N.W., Suite 900

Washington, D.C. 20006

(202) 261 – 2810

(202) 261 – 2835 (facsimile)

[email protected]

[email protected]

Counsel for Plaintiff-Relator




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JURY DEMAND

Pursuant to Rule 38 of the Federal Rules of Civil Procedure, Bryan Arvey demands a jury trial.




19

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing was served via

certified mail, on this 16th 28th day of July 2015, upon:

Loretta Lynch, Esq.

Attorney General of the United States

Office of the Attorney General, Civil Division

U.S. Department of Justice

950 Pennsylvania Avenue, NW

Washington, DC 20530-0001

Rod J. Rosenstein, Esq.

United States Attorney


36 South Charles Street, 4th Floor

Baltimore, Maryland 21201

Roann Nichols, Esq.

Assistant U.S. Attorney


36 S. Charles Street, 4th

Floor

Baltimore, MD 21201

/s

David L. Scher


Documents

IN THE UNITED STATES DISTRICT COURT FOR THE ...wboc.images.worldnow.com/library/f3941f55-295c-4236-8f76...Qui tam relator Bryan Arvey (“Relator” or “Arvey”), by his attorneys,