In brief: Apria settles with gov’t, Viemed backs Verustat

NEW YORK – The acting U.S. Attorney for the Southern District of New York has announced a $40.5 million settlement with Apria Healthcare for alleged fraudulent billing practices for non-invasive ventilators.

The lawsuit alleges, among other claims, that Apria submitted false claims to federal health programs, including Medicare and Medicaid, seeking reimbursement for the rental of non-invasive vents to beneficiaries who were not using the NIVs.

Other claims in the lawsuit: Apria improperly billed federal health programs for certain NIV rentals that were being used in a setting called PAC mode to provide bi-level pressure support therapy, which was available from a less expensive device called VPAP RAD and did not quality for reimbursement at the NIV rate; and the company improperly waived co-pays for a number of Medicare and TRICARE beneficiaries to induce them to rent NIVs.

Apria has also made “extensive factual admissions” regarding its conduct as part of the settlement, including:

• Its RTs often did not conduct regulator visits to NIV patients to confirm that patients were using their NIVs as directed by their physicians.
• It continued to seek payments from federal health programs for NIV rentals each month even though its RTs frequently failed to conduct in-home visits to verify that patients were still using their NIVs.
• It often did not take steps to stop seeking payments from federal health programs or to determine if the NIV rentals were still medical necessary.

“We are pleased to have resolved this civil matter and fully cooperated throughout the review,” an Apria spokesperson said in a statement. “This settlement relates primarily to whether patients made sufficient use of NIVs, prescribed by physicians for use in patients’ homes, and was based largely on data from the early years of the company’s NIV program. Prior to becoming aware of the government’s interest in the matter in 2017, Apria had already made a number of changes to the NIV program’s processes and procedures relating to patient usage in the home. As always, our patients are our top priority and we remain committed to providing outstanding care and exceptional service.”

In addition to the settlement, Apria has entered into a Corporate Integrity Agreement with the Department of Health and Human Services and the Office of Inspector General requiring the company to implement board oversight, a claims review process by an independent review organization and other compliance steps designed to foster adherence to federal health care program requirements and, thereby, protect the programs.

The settlement stems from a whistleblower case filed by three former Apria employees under the qui tam provisions of the False Claims Act.

Viemed acquires stake in Verustat

LAFAYETTE, La. – Viemed Healthcare has acquired a 5% interest in Verustat for $600,000, giving it a platform to enter the remote monitoring space.

Viemed will use Verustat’s RPM solution in conjunction with its own proprietary patient engagement platform (PEP), which has shown to improve patient compliance, along with labor and workflow efficiencies, according to preliminary data.

“The pandemic has revealed a great demand by physicians and patients to safely use technology to provide patient care inside of the home,” said Casey Hoyt, Viemed CEO. “We are excited to be partnering with Verustat in the RPM space, as their unique solution will fit well with our physician network.”

Verustat, which recently became a vendor partner with VGM & Associates, pays providers management fees for introducing their company and its RPM solution to physicians, and helping the company facilitate and manage those relationships.

Viemed expects the RPM platform to add incremental revenue in 2021, while driving new adjacencies, Hoyt says.

“While the RPM space is new, it complements our mission of interacting more frequently with chronically ill patients across multiple disease states, even beyond respiratory illnesses,” he said.