CHARLESTON, W.Va. – The West Virginia
Department of Health and Human Resources Medicaid Fraud Control Unit (MFCU)
announced James Cecil Nance, 43, of Princeton, was arrested on Friday, January
30, 2015 on charges of Medicaid fraud. Nance, Director of Operations for
American Ambulette & Ambulance Service, Inc. DBA Life Ambulance, was
charged with one felony count of bribery, false claims, conspiracy and criminal
penalties.
The MFCU has recovered nearly $40 million in
the past two years as a result of more than 30 investigations which resulted in
criminal complaints or indictments and recovery of funds against Medicaid
providers accused of healthcare fraud or patient abuse, neglect or financial
exploitation, including 16 healthcare fraud cases, 14 patient abuse or neglect
cases, and 1 financial exploitation case. Of the $40 million in total
recoveries, $27 million was allocated to the Medicaid program.
The charges filed in Kanawha County
Magistrate Court arise out of a criminal investigation by the DHHR’s Medicaid
Fraud Control Unit which determined that Life Ambulance ceased to have licensed
advanced life support (ALS) ambulances in West Virginia after June 30, 2012,
but continued to provide and bill for ALS services until the business was closed
on December 6, 2013. Medicaid policy, chapter 524.1, establishes that ambulance
transportation providers must be licensed by and meet the personnel
certification requirements of the West Virginia Bureau of Public Health, Office
of Emergency Medical Services.
According to the criminal complaint, Nance
allowed and directed his employees to provide advanced life support (ALS)
services causing the filing of false claims to the Medicaid program from
October 1, 2012 through December 6, 2013, which resulted in a loss of
$20,589.70. If convicted, Nance faces up to 10 years in prison and a fine
of up to $10,000.
Life Ambulance had offices in St. Albans and
Parkersburg, West Virginia and was part of the First Med EMS corporation that
abruptly shut down on Friday, December 6, 2013.
The Medicaid Fraud Control Unit, through
DHHR’s Office of the Inspector General, investigates and refers for prosecution
allegations of fraud by providers in the Medicaid program, abuse or neglect of
patients in Medicaid-funded facilities and residents in board and care
facilities, as well as fraud in the administration of the program.
Notable civil cases in 2014 by the MFCU
include the record-breaking healthcare fraud settlement of $4.675 million in
the Calloway Labs case, and the recent $1.1 million settlement in the
Trivillian’s Pharmacy case. The civil settlements were pursued in cooperation
with the United States Attorney’s Office, Southern District.
Allison C. Adler, DHHR Communications Director, (304) 558-7899 or Allison.C.Adler@wv.gov