When feds settle, pay attention

Friday, September 30, 2005

LAKE FOREST, Calif. - When Apria agreed to settle alleged Medicare billing improprieties in early August for $17.6 million, HME providers everywhere should have taken note, say industry attorneys.
"The issues that were targeted in the Apria case are likely to be targeted in others," said healthcare attorney Elizabeth Hogue. "Government types are not as knowledgeable about the HME industry as we might think so when they hit pay dirt, they say, 'Ah hah!'"
Apria settled without admission of wrongdoing. Together with legal fees and other related costs, the settlement totals $20 million, the company stated.Whether or not providers can take away anything from the settlement is debatable.
The charges occurred between 1995 and 1998 and may not be relevant today. Nevertheless, cases like this should make providers look at their own businesses to see if the are making similar errors, and, if they are, correct them before investigators come knocking, attorneys say.
"One of the things that providers can do when they see a settlement like this is go to the OIG Web site," Hogue said. "All of the corporate integrity agreements are posted there, and providers can see what the government pinpointed."
"If the government and a whistleblower think something is inappropriate, you better pay attention," added Lester Perling, an attorney with Broad and Cassel in Ft. Lauderdale, Fla. "I always tell clients, 'You can beat the wrap, but you can't beat the ride.' You might have arguments to support something, but if it is a gray area, do you want to be in a position to do so?"
When the government completes a big settlement like the one with Apria, it is not doing anything "nefarious," said Richard Tuten, an attorney with the Health Law Center in Greenville, S.C.
"It is not personal," he said. "They have a job to do, and they do it with zeal. They are on a mission to protect the public funds, and they take it very seriously."