$20M Healthcare Fraud Whistleblower Settlement Reached with Lincare

A healthcare fraud whistleblower settlement of $20 million has been reached to settle allegations that a medical equipment company defrauded the government.

The U.S. Attorney’s Office in Massachusetts confirmed the healthcare fraud whistleblower settlement. Four whistleblowers will share $6 million and their attorneys will receive $5 million. The federal government will receive $9 million.

Defendant Lincare, a subsidiary of The Linde Group in Germany, admitted no liability in the deal.

An amended complaint was unsealed in 2013 and detailed allegations that Lincare billed Medicare for services that were not eligible for reimbursement according to federal guidelines. Other invoiced products and services allegedly were not medically needed or were not actually provided. Still other respiratory items that were provided and billed were in violation of federal regulations.

Lincare allegedly played loosely with other laws by waiving co-pays and deductibles for no reason, paying kickbacks to obtain referrals, and neglecting to process reimbursements when the company was overpaid.

Healthcare Fraud Whistleblower Settlement to Reward Four

Whistleblowers SallyJo Robins, Kathleen D. Dunlap, Germano Lima and Roberto Rabassa accused their employer Lincare of receiving undeserved payments from government programs. Payments allegedly were in excess of what Lincare was due for oxygen and respiratory medical supplies.

In one situation, Lincare allegedly requested and received government reimbursement for oxygen equipment after the customer no longer needed or used the oxygen supplies, said the complaint. Lincare also created evidence to make it appear as though oxygen refills were requested by doctors, when in fact they never were.

Even though Robins and Dunlap worked in the Amherst, New York billing department and Lima and Rabassa worked in Massachusetts in service centers, all four were fired, allegedly in violation of the whistleblower law.

The four employees will benefit from the healthcare fraud whistleblower settlement by virtue of the False Claims Act, which enables citizens to file suit on behalf of the federal government in order to recoup money that was distributed to a company based upon fabricated claims.

Cases in which the U.S Department of Justice joins forces with the plaintiffs are generally more successful. The DOJ did not join this case, but its approval was needed to secure the healthcare fraud whistleblower settlement.

Nearly 80 percent of the cases heard under the False Claims Act involve health care fraud. The volume of reimbursement claims combined with the sheer number of medical products and treatments that qualify for various reimbursement rates make the health care industry particularly vulnerable to fraudulent activity. Most of the time, an employee who witnesses and reports such fraud is the government’s best chance to stop such criminal behavior and ultimately receive reimbursement.

More than 55 federal laws protect or reward whistleblowers, and 44 states plus Washington D.C. provide varying degrees of legal protection.

The Healthcare Fraud Whistleblower Settlement is Case No. 1:10-cv-12256-DPW in the U.S. District Court for the District of Massachusetts.

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