Lincare settles FCA allegations

NEW YORK – Lincare will pay $25.5 million to resolve claims that it violated the False Claims Act by fraudulently continuing to bill federal health care programs for the rental of non-invasive ventilators that patients no longer needed or used.   

The settlement also resolves claims that Lincare violated the Anti-Kickback Statute by waiving coinsurance payments to induce certain Medicare and Tricare beneficiaries to rent NIVs. 

As part of the settlement, Lincare also made factual admissions regarding its conduct. The company admitted that it received reimbursement from federal health care programs for some NIV rental claims that did not comply with all of those programs’ billing rules and guidance. It also admitted that in some instances, it continued to seek monthly payments when it was aware that patients were not using the devices. 

“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 health care programs like Medicare and Medicaid,” said Damian Williams, U.S. Attorney for the Southern District of New York. “Companies will be held accountable for fraudulent billing practices that prioritize profits over legal obligations.” 

As part of the settlement, Lincare admitted and accepted responsibility for certain conduct alleged by the United States, including the following: 

In violation of internal protocols, Lincare’s center clinical staff frequently failed to visit NIV patients every 60 days to confirm that the patients were using their NIVs as directed by their physicians.  Some centers lacked sufficient staff to adequately monitor patient progress and confirm that patients were using the devices as directed by their physicians.  On many occasions, clinical staff did not perform home visits for NIV patients for several months. 

In addition to conducting patient visits, Lincare had the ability to remotely monitor certain patients’ NIV usage for certain newer NIV models through online cloud-based platforms. However, Lincare did not use these systems to confirm that those patients were using the devices as directed.