$5.25 Million Dollar Settlement for Lincare Inc. Announcedby the DOJ
Recently, the U.S. Department of Justice (DOJ) announced that Lincare, Inc., has paid a $5.25 million dollar settlement to resolve allegations that it violated the federal False Claims Act (FCA) and the Anti-Kickback Statute (AKS) by offering illegal price reductions to Medicare beneficiaries.
According to the DOJ announcement, from 2011 to 2017, Lincare attempted to gain a competitive advantage in the marketplace by unlawfully waiving or reducing co-insurance, co-payments, and deductibles for beneficiaries who participated in a Medicare Advantage Plan operated through a private insurer. Lincare's practices violated the Anti-Kickback Statute, and further caused the submission of false claims for payments to Medicare.
The allegations were first brought to light in a 2015 whistleblower lawsuit, filed by a former billing supervisor at Lincare.
This settlement is an important reminder that under most circumstances, co-payments and deductibles should not be waived. This is especially true for Medicare and Medicaid patients:
Unless a patient demonstrates financial hardships, a waived or discounted co-payment or could results in false claims, violations of the AKS, or be determined to be excessive use of items and services paid for by Medicare.
Healthcare Compliance Pros recommends making sure all employees involved with the claim process understand your policies and procedures regarding copays and deductibles. Additionally, we recommend healthcare organizations review their contracts with private payors to see under what circumstances a waived or reduced copay is permissible.