Gov’t sums up healthcare fraud and abuse control

 - 
Friday, January 20, 2017

WASHINGTON – The Department of Health and Human Services and the Department of Justice have released their “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2016.”

The DME-related items in the report include:

  • In March 2016, Respironics paid $34 million to resolve civil False Claims Act allegations for paying kickbacks to DME suppliers to induce those suppliers to buy the company’s masks that treat sleep apnea.
  • In April 2016, Hollister and Byram Healthcare Centers paid $20.8 million to resolve FCA allegations that Hollister paid unlawful kickbacks to Byram with the intent to induce Byram to conduct promotional campaigns designed to refer patients to Hollister’s products.

The report also highlights findings by HHS and the Office of Inspector General that certain DME is available to CMS at a cost well below what is available to state Medicaid agencies. In audits of four state Medicaid agencies, they found that the state could have saved $18.1 million on the purchase of certain DME items if they obtained pricing comparable to pricing under Round 1 of Medicare’s competitive bidding program.