PHILADELPHIA – AdaptHealth LLC, formerly known as QMES, LLC, a provider of durable medical equipment based in Plymouth Meeting, Pennsylvania, will pay $5.3 million to resolve alleged False Claims Act violations for submitting allegedly false claims to federal healthcare programs for respiratory devices that patients did not need or use, in violation of federal healthcare program requirements. The settlement was announced today by United States Attorney Jacqueline C. Romero.
The settlement resolves allegations that between 2013 and 2017, AdaptHealth (known during the period as QMES and Tri-County Medical Equipment and Supply LLC), itself and through certain of its related entities, knowingly and willfully billed federal payors for non-invasive ventilators (“NIVs”) when a patient was instead prescribed and used a BiPAP machine—for which federal payors reimburse suppliers thousands of dollars less per year. The settlement also resolves allegations that AdaptHealth continued billing federal payors for ventilators after patients no longer needed or were using them, and double-billed federal payors for some ventilator rentals in violation of program requirements.
“The integrity of our health care system depends on the government being able to rely on durable medical equipment providers to seek reimbursement for only those devices a doctor has prescribed for their patient and that the patient actually needs and uses,” said U.S. Attorney Romero. “Providers like AdaptHealth have an obligation to ensure that the equipment and devices they rent to patients are medically necessary and properly billed. When companies disregard that obligation to maximize their profits, this Office will hold them accountable.”
“When submitting false claims to federal healthcare programs, providers exploit the trust that they will bill in accordance with the law and instead use the reimbursement process to steal taxpayer dollars,” stated Maureen Dixon, Special Agent in Charge with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG, along with our law enforcement partners, will work to investigate and cease wrongful activity to protect federal healthcare resources.”
“The integrity of the Federal health care programs depends on the honest and accurate submission of claims,” said Conrad J. Quarles, Deputy Assistant Inspector General for Investigations, Office of Personnel Management Office of the Inspector General. “We applaud the efforts of our law enforcement partners and colleagues at the Department of Justice on today’s settlement.”
The settlement resolves a lawsuit originally brought by Michael J. Kelly, a former QMES employee, under the whistleblower, or 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 behalf of the United States and to share in any recovery. Kelly will receive approximately $950,000 of the settlement.
The government’s pursuit of these matters illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The case is being handled by Assistant United States Attorneys Lauren DeBruicker and Veronica J. Finkelstein and Auditor Dawn Wiggins. This settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Eastern District of Pennsylvania; the Department of Health and Human Services, Office of Counsel to the Inspector General and Office of Investigations; and the Office of Personnel Management, Office of the Inspector General.
The lawsuit is captioned United States ex rel. Kelly v. QMES LLC, d/b/a Tricounty Medical Equipment and Supply, LLC, No. 17-cv-0199 (E.D. Pa.). The claims resolved by the settlement are allegations only; there has been no determination of liability.