A recent false claims settlement and perpetrator sentencing highlight the issue of alleged and proven fraud linked to respiratory therapy.
In Massachusetts, North Atlantic Medical Services Inc. agreed to pay $852,378 to settle charges of filing false claims for healthcare services provided by unlicensed staff, the Department of Justice announced. NAMS provides equipment and services to treat respiratory problems such as sleep apnea oxygen deficiency.
The government claimed NAMS used unlicensed personnel to set up sleep apnea masks and oxygen therapy equipment for patients in Massachusetts. This violated a state law requiring clinical licensure of respiratory therapists. The government maintained that, even after the state Department of Public Health told the company its practices were illegal, NAMS kept using unlicensed workers to perform services later billed to Medicare and Medicaid.
"This respiratory care company flouted important licensure requirements, failed to provide patients [with] the standard of care that they deserve and fraudulently billed the federal government for improperly rendered services," said Massachusetts U.S. Attorney Carmen M. Ortiz in the announcement.
The state will receive $229,210 of the settlement, with another $153,428 going to two whistleblowers formerly employed by the company.
Meanwhile in Montana, a respiratory therapist was sent to prison for executing a multi-year Medicaid scam involving just one patient, according to the Justice Department.
Anna Sue Tope was vice president of Eagle Calf Technical Corporation, a supplier of medical equipment and services on the Blackfeet Indian Reservation.
Tope billed Medicaid for more than 108,000 closed-system tracheal suction catheters supposedly delivered to the beneficiary. But after reviewing supplier invoices covering the indictment period, investigators found that Tope had purchased and delivered lower cost catheters known as Cath-n-Glove kits.
"Had the Medicaid program not been misled as to the medical equipment actually being provided, reimbursement to Eagle Calf would have been about $300,000," the announcement noted. But "Tope's fraudulent scheme cost the government $1.4 million."
Tope was sentenced to 12 months and one day in prison.