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Respironics to Pay $34.8 Million for Allegedly Submitting False Claims to Medicare, Medicaid and Tricare Related to the Sale of Sleep Apnea Masks

Respironics to Pay $34.8 Million for Allegedly Submitting False Claims to Medicare, Medicaid and Tricare Related to the Sale of Sleep Apnea Masks

The government’s crackdown on fraud committed against its agencies has resulted in numerous cases involving not only fraud but violations of the Anti-Kickback statute.  An example of this is a case that the Justice Department announced back in March of this year.  In March, the Justice Department that Respironics Inc. had agreed to pay $34.8 million to resolve alleged False Claims Act violations for paying kickbacks.  The government says that these kickbacks took the form of free call center services for durable medical equipment (DME) suppliers that referred Respironics’ sleep apnea masks for the supplier’s patients.  “The payment of illegal remuneration in any form to induce patient referrals threatens public confidence in the health care system,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) prohibits the payment of remuneration to induce the referral of services or items that are paid for by a federal healthcare program such as Medicare, Medicare or TRICARE.  Thus, claims submitted to these programs are in violation of the Anti-Kickback statute and the False Claims Act.  Specifically, the government alleged that Respironics provided free services to DME suppliers to induce them to purchase their sleep apnea masks.  The United States alleged that Respironics provided these call center services to DME companies at no charge on the condition that they refer patients to Respironics’ products.  Moreover, the government alleged that the conduct occurred from April 2012 to November 2015.

“Our commitment has made this district one of the leaders on behalf of whistleblowers.  We hope that those who commit fraud will recognize that it is our goal to make the consequences more than just the cost of doing business,” said U.S. Attorney Bill Nettles of the District of South Carolina.  Respironics will pay roughly $34.14 million to the federal government and roughly $660,000 to various state governments based on their participation in the Medicaid program.  The settlement resolves a lawsuit brought by Dr. Gibran Ameer – who has worked for different DME companies – under the qui tam provisions of the False Claims Act.  The act permits private citizens with knowledge of fraud against the government to bring a lawsuit on the government’s behalf and to share in any recovery.  Under the settlement, Dr. Ameer will receive $5.38 million.

“Medical equipment manufacturers that boost profits by providing kickbacks to suppliers will be held accountable for their improper conduct,” said Special Agent in Charge Derrick L. Jackson of the Department of Health and Human Services, Office of Inspector General (HHS-OIG).  The settlement illustrates the ongoing initiative by the government to crackdown on health care fraud through its Health Care Fraud Prevention and Enforcement Action Team (HEAT).  The initiative began in May of 2009 and to date has recovered more than $27.4 billion through False Claims Act cases with more than $17.4 billion of that recovered in cases involving fraud against health care programs.  If you have knowledge of fraud that has been committed against the government you should report it and contact a Whistleblower law firm.  An attorney there will be able to inform you about your rights under the law.