PA-Based Medical Device Firm Pays $5.3 Million for False Billing Claims

Pennsylvania (WTAJ) — Pennsylvania-based AdaptHealth LLC has to pay more than $5 million for allegedly submitting false claims to federal health care programs, the agency said. Department of Justice (DOJ).

AdaptHealth LLC, Formerly Known as QMES, LLC Settles Alleged False Claims Act Violation for Alleged Submission of False Claims to Federal Health Care Programs for Respiratory Devices That Patients Do Not Need or Use have to pay $5.3 million to do so.

AdaptHealth LLC is a provider of durable medical equipment based in Plymouth Meeting, Pennsylvania.

The settlement provides that, from 2013 to 2017, AdaptHealth (now known as QMES and Tri-County Medical Equipment and Supply LLC) provided non-invasive ventilators (NIV ), it resolves allegations that it deliberately billed federal payers. BiPAP machines allow federal payers to reimburse suppliers for thousands of dollars less annually, according to DOJ.

This resulted in AdaptHealth continuing to charge federal payers for ventilators even after the patient no longer needed or was using a ventilator and/or some Allegations of double charging federal payers for ventilator rentals have also been resolved.

“The integrity of our health care system depends on governments relying on durable medical equipment providers to reimburse only for equipment that doctors prescribe to patients and that patients actually need and use. It depends on whether we can do it,” said U.S. Attorney Jacqueline C. Romero. “Providers like AdaptHealth have a duty to ensure that the equipment and devices they rent to patients are medically necessary and billed properly. , this office holds companies accountable.”

The settlement also resolves a lawsuit filed by former QMES employee Michael J. Kelly under the whistleblower or qui tam provisions of the False Claims Act. According to the DOJ, the law allows private citizens with knowledge of fraud against the government to sue on behalf of the United States and share in the recovery. Kelly will receive approximately $950,000 as part of the settlement.

Tips and complaints from any source regarding potential fraud, waste, abuse or mismanagement may be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).