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Friday, July 12, 2024 | Back issues
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Sleep, O2 Therapy Providers Settle With U.S.

(CN) - North Atlantic Medical Services Inc. agreed to pay $852,378 to resolve allegations it is submitted claims to Medicare and Medicaid for sleep and oxygen therapies provided by unlicensed personnel, the Justice Department announced.

North Atlantic Medical Services is a Massachusetts-based medical device company that does business across the country as Regional Home Care Inc. It's primary business is providing services and equipment for the treatment of respiratory ailments, such as oxygen deficiency and sleep apnea.

Federal prosecutors said the unlawful requests for Medicare and Medicaid reimbursements go back to at least 2002, when North Atlantic Medical Services allegedly first began bulling for oxygen therapy performed by unlicensed practitioners.

As the name implies, oxygen therapy is the administration of supplementary oxygen to treat patients suffering from chronic obstructive pulmonary disease, chronic bronchitis or emphysema.

In 2006, prosecutors say, North Atlantic Medical Services expanded its allegedly unlawful billing practices to its treatments of sleep disorders as well.

Over the years, the company "submitted (or caused to be submitted) thousands of false or fraudulent claims to Medicare, Medicaid and other government health care programs in violation of the Federal and Massachusetts [False Claims Act]," according to a complaint filed in the federal court in Boston.

The government also claims that even licensed therapists working for the defendants failed to make required follow-up visits to patients.

Medicare and Medicaid require suppliers of respiratory therapy equipment and services to comply with state licensing standards. In Massachusetts, the Department of Public Health requires respiratory therapists to apply for and obtain a license.

This settlement resolves allegations that focus specifically on the company's activities between September 2010 to January 2013, the years after the North Atlantic Medical Services received notice from the Massachusetts Department of Public Health that it was breaking the law.

Prosecutors say even after receiving that notice, the company continued to use unlicensed personnel and bill Medicare and Medicaid for these services.

"In addition, by failing to return or refund or notify the United States and/or the Commonwealth that NAMS has received overpayments from Medicare and/or Medicaid and other government healthcare programs, the Defendant is violating and is continuing to violate the Federal and Massachusetts FCAs," the complaint says.

Worse, the government says, "The use of unlicensed personnel and failure to provide follow up visits by licensed personnel in contravention of federal and state law endangers the patient's quality of care, health, and safety."

Under the terms of the settlement, Massachusetts will receive $229,210, while two former NAMS employees Konstantinos Gakis and Demetri Papageorgiou will receive $153,428.

The False Claims Act allows private citizens to file suit for false claims on behalf of the government and to share in the government's recovery.

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