Professional Ambulance, a Providence-based ambulance company located on River Avenue, was raided by federal investigators in late October but is not currently facing any criminal or civil charges and remains fully operational, said the company’s lawyer, Matthew Dawson of Lynch and Pine Attorneys at Law, in a statement.
Ambulance or other healthcare service providers are often implicated in fraud investigations due to suspicion of overcharging, said Tom Forsythe ’74, a former adjunct professor in accounting who currently serves as an audit partner and member of the anti-fraud team at the accounting firm DiSanto, Priest and Co. Forsythe said he has seen a few situations over the past decade that resemble the recent raid.
Kristen Setera, spokesperson for the Federal Bureau of Investigation’s Boston Division, confirmed the agency’s ongoing involvement with the investigation.
Setera and Jim Martin, public information officer for the U.S. Attorney’s Office in Rhode Island, declined to comment further due to the case’s ongoing nature.
Healthcare service providers such as Professional Ambulance often send bills to insurance companies, which eliminates the transparency found in other types of transactions, Forsythe said.
“If you, as an individual, ask to have services done and you’re paying for them personally, you … are concerned about reading a bill when it’s handed to you,” Forsythe said. Insurance companies, unlike people paying out-of-pocket, rarely ask questions, he added.
Forsythe said in instances of fraud, companies similar to Professional Ambulance bill the insurance companies for services that are several grades above what was provided, resulting in a more expensive bill. For example, Forsythe said he has seen businesses charge higher rates associated with services provided by a registered nurse but instead send a licensed nurse to do the job.
Because patients are billed through their insurance cards, an individual patient “doesn’t really know what’s happening,” Forsythe said.
Though the mischaracterization of services may only result in a nominal increase in profit with each overcharge, over time, the payoffs could prove to be substantial, he said. Such exploitative profit margins are attracting attention from the government, which is seeking to enforce more honest practices, as evidenced by several cases of this nature in recent years around the country, multiple news outlets have reported.
“What you saw there was court-authorized activity,” Martin said.
Ambulance companies have been recent targets for fraud investigations, Katherine Harris, spokesperson for the Office of Inspector General, told WPRI.
Professional Ambulance, a locally owned family business founded in 2009, provides emergency and non-emergency transportation contracted through local nursing and assisted living facilities, annually conducting roughly 60,000 transports, according to its website.
Professional Ambulance and its owners were featured as a 2011 small business success story on the U.S. Small Business Administration’s Rhode Island District website and have been honored with community awards for their entrepreneurial success. Representatives of the company declined to comment on the incident.
