Lincare, a supplier of durable medical equipment (DME), agreed to pay $25.5 million to settle allegations it billed federal health programs for the rental of ventilator machines after patients no longer needed to use them.
Lincare also settled allegations it paid kickbacks to Medicare patients and others by waiving co-payments for renting the ventilators, according to the settlement, approved Wednesday in U.S. District Court for the Southern District of New York.
The details: When DME suppliers seek reimbursement for rental of a ventilator, they must send documentation to Medicare that the patient still needs it and it is considered medically reasonable and necessary. Lincare’s policies stated it would send respiratory therapists to patients’ homes every 60 days to check on them and that the ventilators were still needed.
But Lincare’s respiratory therapists, from January 2013 through February 2020, failed on “tens of thousands of occasions” to make the home visits, according to the Department of Justice (DOJ). When they did visit, they allegedly neglected to note how often the patient had been using the ventilator.
Lincare failed to provide documentation patients continued to need a ventilator while it sought reimbursement, according to the settlement. Patients sometimes had not used a ventilator in more than a year. During the period, Medicare typically reimbursed DME suppliers $1,400 per month for rental of a ventilator.
Compliance considerations: Lincare will pay about $24.2 million to the federal government and the remainder of its settlement total to states regarding its alleged violations of the False Claims Act and Anti-Kickback Statute.
The company admitted certain conduct in the settlement, including it received federal reimbursement for claims it knew didn’t comply with billing rules and guidance and continued seeking monthly payments when it knew patients were no longer using ventilators. It also admitted it didn’t follow its internal policy of having a respiratory therapist visit a patient every 60 days.
“When DME suppliers like Lincare knowingly seek federal funds for items that are not medically necessary and not being used, they threaten the sustainability and financial integrity of vital federal healthcare programs like Medicare and Medicaid,” said U.S. Attorney Damian Williams in a press release Thursday. “Companies will be held accountable for fraudulent billing practices that prioritize profits over legal obligations.”
Lincare could not be reached for comment.
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