Medical Equipment Supplier to Pay Massachusetts $230,000 for Allegedly Billing for Unlicensed Respiratory Therapy Services
North Atlantic Medical Services to Pay More than $850,000 to Federal and State Authorities for Submitting False Claims for Services Provided by Unlicensed Personnel
BOSTON – A durable medical equipment supplier based in Leominster has agreed to pay nearly $230,000 to Massachusetts to resolve allegations that it submitted false claims to the state’s Medicaid Program (MassHealth) for respiratory care services provided by unlicensed personnel.
Regional Home Care, Inc., which does business as North Atlantic Medical Services (NAMS), will pay a total of $852,378 to federal and state authorities for its violation of the False Claims Act by billing Medicare and Medicaid for unlicensed services for the treatment of respiratory ailments, such as oxygen deficiency and sleep apnea.
“Companies responsible for in-home respiratory services must comply with licensure requirements to maintain patient safety,” AG Coakley said. “Our office is committed to working with our partners in federal and state law enforcement to ensure these medical equipment suppliers adhere to regulations in Massachusetts.”
From September 2010 through January 2013, NAMS allegedly sent unlicensed employees into patients’ homes to set up sleep apnea masks and oxygen therapy equipment. The Massachusetts Department of Public Health (DPH) requires respiratory therapists to meet professional licensure requirements in order to provide respiratory care paid for by MassHealth. To apply for a Massachusetts license, one must first earn an Associate’s Degree in Respiratory Therapy, or its equivalent, and must pass a licensure examination administered by the National Board for Respiratory Care.
Authorities allege that, even after DPH informed the company that the practice was illegal, NAMS continued to use unlicensed personnel and billed Medicare and Medicaid for these services as if they had been performed by licensed personnel.
The settlement resulted from a lawsuit by a whistleblower, or "relator" under the False Claims Act, originally filed in the United States District Court for the District of Massachusetts. NAMS alleged unlawful conduct caused false and/or fraudulent claims to be submitted to MassHealth, causing the program to pay NAMS close to $230,000 to which it was not entitled.
MassHealth, jointly funded by the states and federal government, provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.
This matter was investigated by the Department of Health and Human Services, Office of the Inspector General, and the Federal Bureau of Investigation, and was handled by the U.S. Attorney’s Office for the District of Massachusetts, along with Assistant Attorney General David M. Scheffler and Investigator Scott Grannemann of AG Coakley’s Medicaid Fraud Division.
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