Medicare fraud continues to unduly burden the system.
The Medicare system is relied on as the only way millions of Americans can afford the healthcare they need. Once citizens reach the age of 65, they become eligible for Medicare, and it can be a tremendous relief to have healthcare coverage that is paid for by the state and offers a cushion in the case of expensive medical treatments. Of course, there are many businesses that supply goods and services to Medicare, so this system in itself is a major industry. Within that system, there are occasionally bad actors who behave inappropriately in an effort to profit in excess of what is legitimate. One such Medicare fraud case was recently settled in the eastern half of Washington State, and the large settlement amount should serve as a warning to other businesses who may be considering heading down a deceitful path.
The notable headline in this case comes from the amount of the settlement – a whopping $29 million. That is the amount being paid by Lincare Holdings, a company based in Florida, along with an agreement to make sweeping changes to the way the company operates and bills for their equipment.
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It was a manipulation of the rules that are in place for the way Medicare reimburses providers that Lincare was able to take advantage of in this matter. The rules establish that providers are able to bill Medicare for the first three years that medical equipment is in use, until the equipment has been paid for in full. At that point, the equipment has to continue to be provided without any further reimbursements being paid. However, Lincare continued the billing after three years had passed, collecting payments from patients long after the payments should have ended. This was a billing issue that was not caught or corrected, and it led to millions of dollars being collected that should not have been received.
As this matter began to unravel, it became clear that the billing issue had been going on for more than a decade. Even though the individual payments on the pieces of equipment provided to payments were typically rather modest, the sum total of the money that was collected incorrectly wound up being in the millions when it was all added up.
It’s often people in vulnerable positions that wind up being victims in cases of healthcare fraud. Commonly, they are elderly, perhaps on a fixed income, and can’t afford to be paying more than they should be for the health care services and products they need. Any form of fraud is wrong and should be punished, but it’s particularly important that the law stands up for the people who might not be able to stand up for themselves.
Will the news of this settlement put an end to any issues with Medicare billing going forward? Of course not – but every time a business is caught acting outside of the law, it is a good opportunity to get the attention of other companies and hopefully pull back on their motivation to do the same.
Sources:
Medical supplier Lincare reaches $29 million settlement for overbilling Medicare, largest ever for health fraud in the region
Medical Supplier Agrees to Pay $29 Million for FCA Violations
Medicare Enrollment Numbers
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