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Princeton man arrested, charged with Medicaid fraud

February 5, 2015 by  
Filed under Blog

CHARLESTON — The West Virginia Department of Health and Human Resources Medicaid Fraud Control Unit (MFCU) announced James Cecil Nance, 43, of Princeton, was arrested on Jan. 30 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.

 

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