Apria Healthcare Group, Inc. (Apria), a durable medical equipment provider that operates throughout the United States, recently agreed to settle a multistate billing fraud claim to the tune of $40.5 million.
The lawsuit prompting the settlement alleged Apria routinely submitted false claims to federal health programs like Medicare and Medicaid to obtain reimbursement for non-invasive ventilators to program beneficiaries who were not using the NIVs or for whom those devices were not medically necessary.
Of the $40.5 million settlement, approximately $37.6 million will be paid to the United States, with the remainder going to various affected states. Apria also admitted fault regarding its conduct in certain instances.
In 2014, Apria started prioritizing expansion of its NIV rentals, because of the large reimbursements that could come from programs like Medicare. However, in expanding these rentals, Apria failed to comply with the basic medical necessity requirements enforced by federal health programs.
Apria was supposed to monitor how patients used their NIVs and would then stop billing when the devices were no longer in use. However, it did not have sufficient staff to conduct this monitoring, and continued billing Medicare and other programs even when it lacked any knowledge as to whether the equipment was still in use. Even once Apria would find out patients no longer used their NIVs, it continued billing federal health programs for reimbursement.
Apria also admitted to engaging in other types of improper conduct to get more NIV orders, including improperly billing federal health programs for NIV rentals that were used in PAC mode, and improperly waiving co-pays for various Medicare and TRICARE beneficiaries to encourage them to rent NIVs.
For more information about the steps you should take if you become aware of healthcare fraud in your organization, contact an experienced whistleblower lawyer at Kardell Law Group.