Durable Medical Equipment Suppliers to Pay $7.5 Million to Resolve False Claims Act Allegations
In May of 2009 the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative was announced by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicaid and Medicare fraud cases through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act under which a private party, or Medicare whistleblower, can sue for false claims on behalf of the government and share in any recovery. It’s thanks to these efforts that cases such as the following are coming to light and getting resolved.
Last month the Justice Department announced that Orbit Medical Inc. and Rehab Medical will pay $7.5 million to resolve allegations that Orbit submitted false claims to federal health care programs for power wheelchairs and accessories. To qualify for these Medicare wheelchair reimbursements, a physician must conduct a face-to-face examination of the beneficiary and provide the supplier with a written prescription for a power wheelchair within 45 days of such an encounter, along with documentation that supports the medical necessity of the device. Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division said, “Power wheelchair suppliers must bill federal healthcare programs accurately and honestly to ensure that federal dollars are used for individuals who truly need these mobility devices.” According to the qui tam lawsuit brought against Orbit, they did not fullfill this obligation.
The settlement with Orbit Medical and Rehab Medical resolves allegations that Orbit sales representatives knowingly altered physician prescriptions and supporting documentation to get orbit’s power wheelchair and accessory claims paid by Medicare, the Federal Employees Health Benefits Plan and the Defense Health Agency. The government alleged that Orbit sales representatives changed or added dates to physician prescriptions and chart notes to falsely document that the prescription was sent to the supplier within 45 days of the face-to-face beneficiary exam; created or altered chart notes and other documents to falsely establish the medical necessity of the power wheelchair or accessory; forged physician signatures on prescriptions and chart notes; and added facsimile stamps to supporting documentation to make it appear as though the physician’s office had sent the documents to Orbit. “The resolution of this case helps to restore funds taken from the Medicare trust fund through the use of falsified records and billings… Health care fraud is aggressively prosecuted in Utah and every effort is made to restore government funds taken through such conduct,” said U.S. Attorney Carlie Christensen of the District of Utah.
The allegations resolved by this settlement were filed by two former Orbit employees; the whistleblowers were reporting Medicare Fraud. The former employees, Dustin Clyde and Tyler Jackson will receive approximately $1.5 million in whistleblower rewards. The whistleblowers’ suit also named as a defendant Jake Kilgore, the former vice president and sales manager at Orbit Medical for the Western region of the United States and this settlement does not resolve the pending claims against Kilgore. –