National respiratory and HME provider Apria Healthcare LLC has agreed to a $40.5 million settlement for fraudulent billing practices, according to the U.S. Attorney’s Office, Southern District of New York.
The suit alleged that Apria submitted claims to federal health programs, such as Medicare and Medicaid, for reimbursement of the rental of non-invasive ventilators when it did not know if the beneficiaries were continuing to use the NIVs, or whether the devices were medically necessary.
Under the settlement, which was approved on Dec. 18 by U.S. District Judge Edgardo Ramos, Apria will pay a total of $40.5 million, with more than $37.6 million going to the United States and the remaining amount to be paid to various states.
Also, as part of the settlement, Apria also made extensive factual admissions regarding its conduct. Some key admissions (among several):
- It relied on the respiratory therapists in its branches to monitor patients’ usage of their NIV devices, and Apria’s RTs were supposed to regularly visit NIV patients to assess whether they used their NIV devices in accordance with their physicians’ instructions.
- However, Aprial RTs often did not conduct those regular visits to NIV patients. For example, an internal analysis found that, in December 2016, Apria’s RTs failed to complete more than half of the visits they should have.
- Apria continued to seek monthly reimbursement from federal health programs for the NIV rentals despite RTs frequently failing to conduct the in-home verification of use visits..
- Moreover, when Apria RTs indicated the visits showed patients had stopped using their NIVs, the company often did not stop seeking reimbursement or work to determine if the NIV rentals were still medically necessary.
“DME providers like Apria have an obligation to ensure that the equipment and devices they rent to patients are medically necessary,” acting U.S. Attorney Audrey Strauss said. “When companies knowingly disregard that obligation to maximize their profits, this Office will hold them accountable for their fraudulent conduct.”
“Apria’s conduct compromised the integrity of the Medicare and Medicaid programs, and needlessly increased the financial burden on taxpayers,” HHS-OIG Special Agent in Charge Scott J. Lampert added. “Along with our law enforcement partners, HHS-OIG will continue to ensure that those individuals and entities that bill federal health care programs improperly are held accountable for their actions.”