Mercy Respiratory Care and Med Supply: Billing After the Purchase Price Was Reached

In the Mercy Respiratory Care DME settlement, Catholic Health Initiatives, Health at Home agreed to pay $189,061 over allegations that it kept charging Iowa Medicaid after the equipment’s purchase price had been reached. For someone working with equipment rental accounts, the important evidence may be in the running total and the charges that continued after it crossed the limit.

The Des Moines, Iowa business operated as Mercy Respiratory Care and Med Supply. The Justice Department announced the settlement on May 4, 2018.

Iowa Medicaid Billing After the Purchase Price

Mercy allegedly kept billing Iowa Medicaid for equipment after reaching its purchase price.

For someone working with these accounts, the comparison is specific: what had the supplier billed and received for the equipment before the next charge went out? We examine that connection with an insider who knows the billing operation, including the purchase-price basis and the payer’s terms for the item.

Respiratory Equipment Billing and Rental Limits

Equipment payment limits depend on the payer and the item. Mercy’s case concerned Iowa Medicaid charges that allegedly continued after the equipment’s purchase price was reached.

The Billing History an Insider Can Explain

For an allegation like Mercy’s, we would connect the equipment’s purchase-price basis to the account’s charges and payments, then identify the later bills. The insider’s value is knowing how those bills were generated.

A billing employee may know where the running total appears and how the next charge gets generated. Someone reviewing payments may recognize an account that has reached its purchase-price limit while further charges keep going out. The useful account of the conduct connects those observations to the same equipment, payer and billing period. That is how a concern about recurring charges becomes a specific account of what the government was asked to pay.

We also want to understand the decisions behind the continued billing. Did staff flag the account? What did the people responsible for billing do with that information? The transaction history explains the money, while an employee’s firsthand account can explain why the charges continued. A separate oxygen-equipment settlement shows how much that second part can matter.

Lincare: When Employees Flagged the Oxygen Billing

In its separate oxygen-equipment qui tam case, Lincare Holdings admitted billing past Medicare payment limits and telling employees who raised concerns that the billing practices would continue.

Medicaid Durable Medical Equipment Billing and Whistleblower Cases

Equipment billing also features prominently in Medicaid civil enforcement against health care providers. The HHS Office of Inspector General’s Medicaid Fraud Control Units Fiscal Year 2023 Annual Report, published in 2024, found that medical-device manufacturers and durable medical equipment suppliers accounted for more civil settlements and judgments than other provider types that year.

For an insider in healthcare billing, the Mercy allegation points to a concrete issue worth discussing: the purchase-price limit and the charges submitted after it. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Why the Charges Continued

If you saw equipment accounts keep billing past a purchase-price limit, tell our whistleblower experts what happened inside the billing operation. We work beside you to build the case around those accounts and bring in durable medical equipment fraud whistleblower lawyers who understand payer limits and recurring claims. We stay with you through the case, connecting your knowledge of the business to the government’s recovery.