North Atlantic Medical Services Inc. (NAMS), doing business as Regional Home Care Inc., will pay $852,378 to resolve allegations that it violated the False Claims Act by submitting claims to Medicare and Medicaid for respiratory therapy services provided by unlicensed personnel.
The government’s investigation was started by a qui tam, or whistleblower, lawsuit filed under the False Claims Act by former NAMS employees Konstantinos Gakis and Demetri Papageorgiou.
Gakis and Papageorgiou will split $153,428, the DOJ said Monday.
NAMS is a medical device company based in Massachusetts that provides equipment and services for the treatment of respiratory ailments, such as oxygen deficiency and sleep apnea.
Medicare and Medicaid require suppliers of respiratory therapy equipment and services to comply with state licensing standards. In Massachusetts, the Department of Public Health requires respiratory therapists to have a license. Applicants for licenses must pass the National Board for Respiratory Care’s “Certification Examination for Entry-Level Respiratory Therapy Practitioners” or obtain a reciprocal license from a different jurisdiction.
The settlement resolves allegations that from September 2010 to January 2013, NAMS used unlicensed employees to set up sleep apnea masks and oxygen therapy equipment for patients in Massachusetts.
The government alleged that NAMS continued to use unlicensed personnel and bill Medicare and Medicaid for these services even after the Massachusetts Department of Public Health informed the company that the practice was illegal.
U.S. Attorney Carmen M. Ortiz for the District of Massachusetts said, “With the important assistance of whistleblowers, our health care fraud team seeks to ensure patient safety and protect the public.”
Massachusetts, which paid for part of the Medicaid claims at issue, will receive $229,210 of the settlement amount.
The False Claims Act allows private citizens to file suit for false claims on behalf of the government and to share in the government’s recovery.
Since January 2009, the DOJ has recovered a total of more than $23.2 billion through False Claims Act cases. Nearly $15 billion of that amount was recovered in cases involving fraud against federal health care programs.
During the fiscal year that ended September 30, the government paid out $435 million to the whistleblowers who filed qui tam complaints.
Richard L. Cassin is the publisher and editor of the FCPA Blog. He can be contacted here.