On April 25, 2023, Sidney L. Gold & Associates, P.C. announced the settlement of a landmark $5.3 million Whistleblower Medicare Fraud case against AdaptHealth LLC, formerly QMES LLC, for submitting allegedly false claims to federal healthcare programs for respiratory devices that patients did not need or use in violation of federal healthcare requirements.
The settlement resolves allegations that between 2013 and 2017, AdaptHealth (known during the period as QMES and Tri-County Medical Equipment and Supply LLC), itself and through certain of its related entities, knowingly and willfully billed federal payors for non-invasive ventilators (“NIVS”) when a patient was instead prescribed and used a BiPAP machine, for which federal payors reimburse suppliers thousands of dollars less per year. The settlement also resolves allegations that AdaptHealth continued billing federal payors for ventilators after patients no longer needed or were using them, and double-billed federal payors for some ventilators rentals in violation of program requirements. The claims resolved by the settlement are allegations only, there has been no determination of liability.
The settlement resolves a lawsuit originally brought by Michael J. Kelly, a former QMES employee, who was represented by Sidney L. Gold, Esquire and a former associate, Neelima Vanguri, Esquire under the whistleblower, or qui tam provisions of the False Claims Act. The Act permits private citizens with knowledge of fraud against the government to bring a lawsuit on behalf of the United States and to share in any recovery. The government’s pursuit of these matters illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act.
The settlement achieved was the result of a five-year coordinated effort by Sidney L Gold & Associates and the United States Attorney’s Office for the Eastern District of Pennsylvania.
If you believe someone has knowingly committed Medicare or Medicaid fraud and you would like to learn more about bringing a Medicare or Medicaid whistleblower lawsuit, the qui tam lawyers at Sidney L. Gold & Associates, P.C. can help you. We understand qui tam litigation, have a proven track record, and strive to achieve the best possible results for our clients.