The Effingham Daily News reported in August, 2018, that Lincare Inc., a major provider of oxygen and respiratory therapy services and other medical equipment agreed to a $5.25 million dollar settlement. The company was charged with violating both the False Claims Act and the Anti-Kickback Statute. Lincoln’s company headquarters are in Florida.
The allegations of fraud
The government claimed that Lincare, between 2011 and 2017: “Unlawfully waived or reduced co-insurance, copayments, and deductibles” to gain a competitive edge. The reduced payment obligations applied to “beneficiaries who participated in a Medicare Advantage Plan.” Medicare Advantage is run by private insurers but is funded, in large part, by the government.
The claim involves an expanded definition of the False Claims Act. Normally false billing claims include payments by Medicare or another federal agency. Here, the payments were made by a private insurer – but one that is partially funded by Medicare. The U.S. Attorney, Steven D. Weinhoeft, claimed that Lincare’s practice “caused the submission of false claims for payments to Medicare.
The settlement, according to U.S. Attorney Weinhoeft, helps protect Medicare’s integrity.
The whistleblower action that began the federal lawsuit against Lincare
Brian Thomas, a former billing supervisor for Lincare, initiated the lawsuit in 2015 when he brought a False Claims Act (FCA) lawsuit. In FCA and other whistleblower lawsuits, the individual who begins the lawsuit is generally entitled to a percentage of any recovery. In this case, Mr. Thomas percentage of the recover amounts to $918,750. Mr. Thomas filed his claim in Illinois.
The whistleblower and the government claimed that that the partial or full waivers were given to encourage customers to use Lincare’s products instead of a competitor’s products. Lincare received reimbursements at higher rates from the private insurer than that of its competitor. Mr. Thomas claimed Lincare’s actions were in violation of the Anti-Kickback statute and the False Claims Act.
Whistleblower claims require the aid of experienced whistleblower lawyers. The disclosures must be made in a timely and proper manner to the government. Claims that are public knowledge or subsequent to a prior valid claim are not eligible for a recovery. Claims are generally kept private until the case is resolved.
To learn if you have a valid whistleblower claim, please call Stephen Danz & Associates at 877-789-9707 to arrange a free consultation.