The Lincare Settlement Agreement: What You Need to Know
Recently, Lincare Holdings, Inc. entered into a settlement agreement with the U.S. Department of Justice (DOJ) to resolve allegations that it violated the False Claims Act (FCA) by submitting false claims for reimbursement to Medicare and Medicaid for respiratory therapy services.
The settlement agreement requires Lincare to pay $20 million to the DOJ in order to resolve these claims, making it one of the largest FCA settlements in 2019. Additionally, Lincare has agreed to implement a corporate integrity agreement (CIA) with the U.S. Department of Health and Human Services Office of Inspector General (OIG) to ensure future compliance with federal healthcare program requirements.
So, what exactly did Lincare do wrong?
The allegations against Lincare involve the provision of home oxygen and respiratory therapy services to patients. Specifically, Lincare was accused of submitting claims for reimbursement to Medicare and Medicaid for services that were not medically necessary or were not actually provided to patients. Allegedly, Lincare also improperly waived co-payments for Medicare beneficiaries, which is prohibited under federal law.
Furthermore, Lincare was accused of engaging in improper billing practices, such as billing Medicaid for services that were already paid for by Medicare or billing for services that were not covered by Medicaid.
The DOJ and OIG initiated an investigation into Lincare’s billing practices after receiving a whistleblower complaint in 2016. The investigation ultimately led to the settlement agreement announced in August 2019.
As part of the settlement agreement, Lincare has also agreed to cooperate with ongoing investigations into its billing practices and to implement significant compliance and auditing measures over the next five years.
The significance of the Lincare settlement agreement is twofold. First, it serves as a reminder of the government’s commitment to combat healthcare fraud and abuse, particularly in the home healthcare space. Second, it demonstrates the importance of effective compliance programs for healthcare providers to avoid costly penalties and legal action.
As healthcare providers face increasing scrutiny over their billing practices, it is critical that they implement and maintain effective compliance programs that address fraud, waste, and abuse risks. These compliance programs should include policies and procedures to ensure billing for only medically necessary services, thorough documentation and recordkeeping, regular auditing and monitoring of billing and coding practices, and comprehensive employee training on compliance regulations.
In conclusion, the Lincare settlement agreement serves as a warning to healthcare providers to ensure they are billing for only medically necessary services and maintaining effective compliance programs. Failure to do so can result in costly penalties and legal action, as evidenced by the $20 million settlement with Lincare. It is essential for providers to stay informed on healthcare regulations and industry trends in order to remain compliant and continue providing high-quality care to patients.