Whistleblower details alleged fraud at Lincare

CLEARWATER, Fla. - A former employee says Lincare has been knowingly defrauding the government of millions of dollars by allegedly billing false claims to Medicare.

“(Lincare) has engaged in a scheme to wrongfully enrich itself at taxpayers' expense by fraudulently billing Medicare for equipment rental for which either the patients or the equipment were not reimbursable by Medicare, by failing to provide services to patients it was obligated to provide, and by retaining overpayments to which it new it was not entitled,” alleges Rebecca Saiff in a whistleblower lawsuit unsealed July 1 by the U.S. District Court for the Middle District of Florida in Tampa.

Saiff worked for Lincare as a Medicare billing specialist at the corporate headquarters from January to July of 2013, and at its Largo, Fla., regional billing and collection office from August of 2013 until February 2014. She filed her lawsuit under seal in April 2014.

More specifically, Saiff alleges that Lincare:

• Improperly adjusts billing dates to bill Medicare for equipment rental on days during which patients were not using the equipment (i.e. days when patients were in a skilled-nursing facility or hospital);
• Circumvents the competitive bidding program by submitting claims in areas for which it did not have a contract;
• Retains overpayments made by Medicare for equipment that has already reached the 36-month cap on payments;
• Refuses to perform its contractual obligations to repair rental equipment for five years after its provision to beneficiaries; and
• Bills Medicare for equipment rented to beneficiaries who did not qualify for such equipment.

Saiff alleges that Lincare provides incentives to employees to submit false claims to its billing offices.

“Lincare has achieved this by instituting a policy that store managers and/or sales persons are entitled to be paid commission once a claim is submitted to the accounts receivable department (i.e. before any determination has been made as to whether the relevant insurer will actually pay the claim),” the lawsuit states. “This has led to an overwhelming number of submissions from the stores that are plainly deficient on their face.”

Saiff seeks, among other relief, $5,500 to $11,000 for each violation of the False Claims Act, plus three times the amount of damages the U.S. has sustained because of Lincare's alleged misconduct.