[News] Apria admits fraudulent billing practices [in $40 million NY settlement] - Printable Version +- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums) +-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area) +--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum) +--- Thread: [News] Apria admits fraudulent billing practices [in $40 million NY settlement] (/Thread-News-Apria-admits-fraudulent-billing-practices-in-40-million-NY-settlement) |
Apria admits fraudulent billing practices [in $40 million NY settlement] - ApneaNews - 12-15-2021 The link to this news was previously posted in another thread, but I thought it deserved it's own thread... It's kind of old news (from 2020), but I'm not sure if everyone knew about it or not... Department of Justice U.S. Attorney’s Office Southern District of New York FOR IMMEDIATE RELEASE Monday, December 21, 2020 Acting Manhattan U.S. Attorney Announces $40.5 Million Settlement With Durable Medical Equipment Provider Apria Healthcare For Fraudulent Billing Practices Apria Admits It Continued to Seek Reimbursement from Federal Programs When It Did Not Know If Patients Were Continuing to Use Their Non-Invasive Ventilator Rentals and After It Had Information Indicating That Patients Had Stopped Using Their Ventilators Audrey Strauss, the Acting United States Attorney for the Southern District of New York, Scott Lampert, the Special Agent in Charge for the New York Office of the Inspector General of the U.S. Department of Health and Human Services (“HHS-OIG”), Patrick J. Hegarty, Special Agent in Charge of the Northeast Field Office of the U.S. Department of Defense - Office of Inspector General’s Defense Criminal Investigative Service (“DCIS”), and Norbert E. Vint, Deputy Inspector General Performing the Duties of the Inspector General, Office of Personnel Management Office of the Inspector General (“OPM OIG”), announced today a $40.5 million settlement of a fraud lawsuit against Apria Healthcare Group, Inc. and its affiliate, Apria Healthcare LLC (together, “Apria”), a large durable medical equipment (“DME”) provider with approximately 300 branch offices located throughout the United States. The lawsuit alleges, among other claims, that Apria submitted false claims to federal health programs, including Medicare and Medicaid, seeking reimbursement for the rental of costly non-invasive ventilators (“NIVs”) to program beneficiaries who were not using the NIVs such that the devices were not medically necessary or that involved the improper waiver of patient co-insurance payments. Under the settlement, which was approved on December 18 by U.S. District Judge Edgardo Ramos, Apria agreed to pay a total sum of $40.5 million, with $37,632,789.89 being paid to the United States and the remaining amount to be paid to various states. As part of the settlement, Apria also made extensive factual admissions regarding its conduct. Acting U.S. Attorney Audrey Strauss said: “It is critical to the financial integrity of federal health programs like Medicare and Medicaid that reimbursements are made only for medically necessary items and services. DME providers like Apria have an obligation to ensure that the equipment and devices they rent to patients are medically necessary. When companies knowingly disregard that obligation to maximize their profits, this Office will hold them accountable for their fraudulent conduct.” HHS-OIG Special Agent in Charge Scott J. Lampert said: “Apria’s conduct compromised the integrity of the Medicare and Medicaid programs, and needlessly increased the financial burden on taxpayers. 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.” DCIS Special Agent in Charge Patrick J. Hegarty said: “The Defense Criminal Investigative Service (DCIS) is committed to protecting the integrity of TRICARE, the healthcare system for military members and their families. Charging TRICARE for DME that was not necessary betrays the public’s trust. This settlement demonstrates our partnership with HHS-OIG, OPM-OIG and the U.S. Attorney’s Office to investigate fraudulent schemes that impact TRICARE and put its beneficiaries at risk.” OPM OIG Deputy Inspector General Norbert E. Vint said: “The OPM OIG is committed to fighting all forms of health care fraud. As demonstrated by this settlement, providers that exploit federal health care programs by submitting false claims will be held accountable.” As alleged in the complaint filed by the United States, Apria decided in 2014 to prioritize the expansion of its NIV rental business because health care programs like Medicare paid as much as $1,400 per month to cover NIVs, a type of complex respiratory equipment that can dynamically adjust the pressure level of air delivery. That expansion, however, came at the cost of Apria’s compliance with the basic medical necessity requirement of federal health programs. Specifically, while Apria knew that it was responsible for monitoring patients’ utilization of their NIVs and to stop billing when NIVs were no longer being used, it did not have enough staff, or “respiratory therapists,” to conduct such monitoring. As a result, Apria routinely billed Medicare and other programs when it did not know whether NIVs were still being used by patients and, therefore, remained medically necessary. Further, even when Apria had information indicating that patients were no longer using their NIVs, it often continued to bill the federal health programs. As further alleged, Apria engaged in two other types of improper practices to obtain more NIV orders and higher profits. First, Apria improperly billed federal health programs for certain NIV rentals that were being used in a setting called PAC mode to provide bi-level pressure support therapy, which was available from a less expensive device called VPAP RAD and did not qualify for reimbursement at the NIV rate. Second, Apria improperly waived co-pays for a number of Medicare and TRICARE beneficiaries to induce them to rent NIVs. For example, Apria employees offered to waive co-pays to convince patients to rent NIVs from Apria instead of competitors. Further, Apria also waived co-pays without making the required individualized assessment of financial need. As a result of those three widespread improper practices, Apria submitted thousands of false claims to federal health programs for NIV rentals and fraudulently received millions of dollars in reimbursements. As part of the settlement, Apria admitted, acknowledged, and accepted responsibility for, among others, the following conduct: NIV Continued Use Conduct
This settlement arises from a whistleblower case filed by three former Apria employees under the qui tam provisions of the False Claims Act, which allow private persons – known as “relators” – to file civil cases on behalf of the United States and share in the recovery. Acting U.S. Attorney Strauss thanked the Washington State Medicaid Fraud Control Unit for its extensive collaboration in the investigation and resolution of this case, and also praised the outstanding investigative work of the HHS-OIG, DCIS, and OPM-OIG. This case is being handled by the Office’s Civil Frauds Unit. Assistant U.S. Attorneys Li Yu and Steven Kochevar and former Assistant U.S. Attorney Casey Lee have handled the case. Fair Use applies, original link: https://www.justice.gov/usao-sdny/pr/acting-manhattan-us-attorney-announces-405-million-settlement-durable-medical-equipment RE: Apria admits fraudulent billing practices [in $40 million NY settlement] - sawinglogz - 12-15-2021 This would explain why my DME (not Apria) is now asking at every resupply call if I'm still using my machine. RE: Apria admits fraudulent billing practices [in $40 million NY settlement] - S. Manz - 12-15-2021 Yeah, I heard about it a year ago. The settlement of $40 million was pocket change for these guys and the funniest thing was that almost $38 million went to the feds and states involved ( I think all the lower 48) got like $2.5 million between them... ....and actual patients got nothing or it will take years before anyone on the lower end of the totem-pole sees a dime . RE: Apria admits fraudulent billing practices [in $40 million NY settlement] - JohnReam - 01-31-2022 And Apria still screwing their customer into 2022 Apria is double billing consumer customers like me and you. Totally intentional. They are getting unsuspecting consumers to pay twice. Good luck getting a refund. Here is how their double billing tactic works:
These folks should be reported to the consumer protection agency. -----
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