On August 28, the United States Attorney for the Eastern District of Washington announced that Lincare Holdings, Inc. agreed to pay $29 million to settle charges that it violated the False Claims Act (FCA) by overbilling Medicare and Medicare Advantage Plans for oxygen equipment. The settlement is the largest-ever health care fraud settlement in the Eastern District of Washington.
The settlement stems from a qui tam whistleblower suit filed by two former Lincare employees. The False Claims Act’s qui tam provisions enable private citizens to file lawsuits on behalf of the government if they know of an individual or company defrauding the government. Qui tam whistleblowers are eligible to receive between 15 and 30% of the government’s recovery. In this settlement, the whistleblowers are set to receive $5,655,000.
The case centers around oxygen equipment which leased to patients with respiratory ailments such as Chronic Obstructive Pulmonary Disease (COPD). The U.S. Attorney’s press release explains that “[b]etween 2012 and 2023, traditional Medicare (also known as Medicare Part B) reimbursed providers such as Lincare for the lease payments on oxygen equipment, but after three years of monthly lease payments, providers such as Lincare were required to continue to provide the oxygen equipment to the patient, but were not eligible for additional rental payments because Medicare had already reimbursed the provider for the full purchase price of the equipment.”
As part of the settlement, Lincare “admitted that it improperly billed Medicare, MA Plans, and beneficiaries for oxygen equipment rental payments and co-payments after it had already received 3 years of payments,” the U.S. Attorney for the Eastern District of Washington reports.
“One of the most important responsibilities we have is protecting vulnerable members of our community such as the elderly,” said U.S. Attorney Vanessa Waldref. “Elderly members of our community are among the most likely to be targeted by fraud, false billing scams, and abuse. This is one reason that the U.S. Attorney’s Office, the Department of Justice, and our law enforcement partners, have made combatting elder fraud and abuse a top priority.”
“I also want to recognize the two whistleblowers who came forward and provided vital information, making this result possible,” stated Assistant United States Attorney Dan Fruchter. “We will continue to work hand-in-glove with courageous whistleblowers, as well as HHS-OIG and our other law enforcement partners, to protect patients and the community from fraud and abuse that targets the elderly.”
On July 25, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.
“The False Claims Act is America’s number one fraud-fighting law,” said whistleblower attorney Stephen M. Kohn. “These amendments are urgently needed to ensure that whistleblowers can continue to play their key role in protecting taxpayers from corporate criminals.”
Further Reading:
Bipartisan Legislation Unveiled to Strengthen False Claims Act