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Case Number: 2:21-cv-151
Judge: Thomas O. Rice
Court: United States District Court for the Eastern District of Washington (Spokane County)
Plaintiff's Attorney: United States Attorney’s Office in Spokane
Defendant's Attorney: Matthew Crotty
Description: Spokane, Washington civil litigation lawyers represented accused of fraudulently overbilling Medicare and Medicare Advantage Plans for oxygen equipment.
Lincare Holdings, Inc. a Florida based, wholly-owned subsidiary of German multinational chemical corporation Linde, PLC, provides oxygen equipment to patients with respiratory ailments such as Chronic Obstructive Pulmonary Disease (COPD), including leasing oxygen tanks and home and portable oxygen concentrators to assist patients to breathe while in the home or traveling. Between 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. Under Medicare Advantage, also known as Medicare Part C, Medicare Beneficiaries may elect to receive their Medicare benefits through a private insurance plan offered by an insurance company, known as a Medicare Advantage Plan or an “MA Plan.” MA Plans are required to provide the same coverage and benefits as traditional Medicare, but they may set their own rules for reimbursement and beneficiary co-pays. Between 2016 and 2023, many Medicare Advantage Plans adopted the same requirement that limited providers like Lincare to three years of rental payments for oxygen equipment. After 3 years of payments, Lincare and other providers were required to continue to provide the equipment for the remainder of its useful life, but were not permitted to charge rental payments to MA Plans, or charge any co-payments to beneficiaries.
In the settlement announced today, 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. Lincare admitted that it lacked adequate controls to ensure that MA Plans and beneficiaries were not improperly billed after 3 years of rental payments had already been received. Lincare additionally admitted that for traditional Medicare recipients, it had controls in place to prevent improper billing, but that those controls were not always effective. Finally, Lincare admitted that when Lincare employees raised concerns about Lincare’s billing practices, Lincare officials in its Regional Billing and Collections Office located in Spokane Valley, Washington, and at Lincare’s corporate headquarters in Clearwater, Florida, instructed them that Lincare would continue its billing practices. The settlement announced today resolved claims that Lincare’s conduct violated the False Claims Act.
“One of the most important responsibilities we have is protecting vulnerable members of our community such as the elderly,” said U.S. Attorney 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 am appalled by Lincare’s admitted past practice of putting profits before its obligations to patients and to the Medicare program, and in particular by Lincare’s admitted improper practice of wrongfully collecting co-pays from elderly beneficiaries on fixed incomes and with limited means. That said, I am heartened that, following our investigation, Lincare stepped up, accepted responsibility, and committed to make things right, not only by refunding overpayments received by Medicare, but by identifying and repaying any beneficiaries from which it improperly collected co-payments. I am also encouraged that Lincare has, as part of our settlement, entered into a five-year corporate integrity agreement to take significant corrective actions to ensure this conduct does not recur. As part of those corrective actions, Lincare has agreed to pay for and undertake an independent review of its claims and billing practices. Lincare has also designed and implemented new billing software and other reforms to ensure that Lincare bills appropriately going forward.”
“By billing Medicare Advantage Plans and their beneficiaries beyond the allowed three years, Lincare threatened the integrity of taxpayer-funded health care programs and prevented valuable resources from reaching their intended recipients,” said Steven J. Ryan, Special Agent in Charge at the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “We are hopeful that with the implementation of a Corporate Integrity Agreement, Lincare will invest in controls to ensure that all plans are billed appropriately. HHS-OIG is committed to protecting federal health care programs from fraudulent and wasteful practices at the hands of providers.”
As part of the settlement, Lincare entered into a 5-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). That Agreement requires, among other things, that Lincare implement a robust compliance and reporting program as well as a number of significant billing reforms and practices. Additionally, the Agreement requires that Lincare retain, at its expense, independent experts to review its claims and billing practices to ensure they are appropriate.
Assistant United States Attorney Dan Fruchter stated that “I want to express special appreciation for the exceptional investigative and analytical work performed by HHS-OIG in this case. This was a complex case with novel issues, and this result would not have been possible without the hard work, investigative skill, and subject matter expertise of our partners with HHS-OIG. I also want to recognize the two whistleblowers who came forward and provided vital information, making this result possible. 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.”
According to court documents, the case began in May 2021, when two whistleblowers, former employees in Lincare’s center in Libby, Montana, filed a qui tam complaint under seal in the U.S. District Court for the Eastern District of Washington. When a whistleblower, or “relator,” files a qui tam complaint, the False Claims Act requires the United States to investigate the allegations and elect whether to intervene and take over the action or to decline to intervene and allow the relator to go forward with the litigation on behalf of the United States. The relator is generally able to then share in any recovery. In this case, according to court documents, the United States intervened in the action in July 2023, and subsequently reached this settlement. Pursuant to the settlement agreement, the relator will receive $5,655,000 of the total settlement amount.
The settlement was the result of a joint investigation conducted by the U.S. Attorney’s Office for the Eastern District of Washington and the U.S. Department of Health and Human Services, Office of Inspector General, Seattle Field Office. Assistant United States Attorneys Dan Fruchter, Tyler H.L. Tornabene, and Frieda K. Zimmerman of the Eastern District of Washington handled this matter on behalf of the United States.
Outcome: Defendant agree to pay $28 million to settle the claims made against it by the Government.