Court papers state that the employees conducted the fraudulent activity “at the behest of the owners.”
Guam – Two top level employees at Guam Medical Transport, a local medical transportation company, are facing healthcare fraud charges in federal court in an alleged conspiracy that involves over $30 million. The employees, general manager Jared Ada and billings manager Trevor Cruz have already signed plea deals.
According to a criminal complaint filed in the District Court of Guam, Guam Medical Transport owners and employees were involved in an elaborate scheme to defraud the US government out of Medicare reimbursements.
The amount cited in the complaint that GMT allegedly filed claims for is more than $30 million.
Two employees have signed plea agreements so far: the general manager, Jared Ada, and billings manager Trevor Cruz. While the suit accuses the owners of GMT as being involved in the conspiracy to defraud the federal government, it does not name who the owners are. According to the company’s website, GMT was founded in 2009 by Clifford Shoemake, Casey Conner and Michael Brazel.
Court papers say that between 2010 and 2014, both Ada and Cruz falsified Medicare claims to be able to get reimbursements from Medicare and TriCare.
“As part of the scheme to defraud and at the behest of GMT’s owner,” the complaint states, “the defendants submitted and caused to be submitted claims to Medicare and TriCare that were materially false.”
Most of GMT’s clients were dialysis patients with end stage renal disease. In order for a patient to qualify for medical transport under the Medicare program, the patient must prove that they have a medical necessity.
But court paper say that many of GMT’s patients “could walk and/or take other means of transportation service” and that despite knowing this, Ada and Cruz continued to submit claims for beneficiaries who did not qualify for medical transportation services.
The plea agreement states that Ada coached patients to hide their ability to walk in order to prove that these patients needed medical transport. Patients’ personal expenses were even paid for, such as housing, food and Medicare premiums, just so GMT could continue to file claims for these beneficiaries and receive Medicare reimbursements, court paper state.
Furthermore, when the FBI launched an investigation into the company, Ada and Cruz allegedly submitted falsified documents in an effort to “obstruct the investigation.”
Cruz, according to his plea agreement, instructed emergency medical technicians to alter documents to make it appear as though these clients qualified for Medicare coverage.
During the four years the alleged conspiracy went on, the company billed over $30 million and received close to $11 million in payments from Medicare and TriCare.
Back in May 2014, PNC reported that GMT had to let go of dozens of employees after a new Medicare claims contractor changed the Medicare requirements for ambulatory services.
At the time, GMT noted that as a result of the Medicare changes, they were forced to cease services to many dialysis patients. And although some of these patients were able to walk, their doctors still recommended non-emergency medical transport. In some instances, some dialysis patients who couldn’t walk and still clearly needed medical transportation were still being denied by Medicare.
Messages to GMT’s management were not returned as of news time.