La Fuente Ocular Prosthetics: The Overpayment the Supplier Failed to Repay

The La Fuente Ocular Prosthetics exclusion followed an unpaid overpayment at an Oklahoma City supplier the inspector general had accused of false Medicare claims. Its independent reviewer had found money the company needed to return. La Fuente failed to repay it, and the HHS Office of Inspector General excluded the supplier for five years beginning September 14, 2018, for breaching its corporate integrity agreement.

The Second Annual Review Found Money to Return

La Fuente’s Independent Review Organization identified the overpayment during the company’s second annual reporting period. The inspector general treated the failure to repay it as a material breach of the corporate integrity agreement. The enforcement action centered on what the supplier did after the review reached its finding.

That is the part of this case a billing or compliance employee may recognize. The review finding reaches the business, but the money does not go back. Someone inside may know who received the finding, what management said about it and how the company handled the repayment. Those are questions we explore with an insider, because the response to the finding is part of the story.

Different Agreements, Different Unpaid Obligations

La Fuente also defaulted on payments under a separate settlement with the inspector general. In its account of that default, the agency said it had accused La Fuente of submitting false Medicare claims and creating false records to support them. That default prompted an exclusion on August 21, 2018.

One obligation was to make the settlement payments. The other was to repay the overpayment the independent reviewer found. La Fuente failed to meet both. The original Medicare allegations explain why the settlement mattered; the later review finding shows how an unpaid obligation could surface within the company’s compliance work.

Prosthetics Suppliers Bill for the Item

Prosthetics sit within the supplier-billed side of medical-device reimbursement. That differs from an implanted device whose cost is included in payment for a procedure.

This puts the supplier’s billing operation close to the payment being reviewed. In La Fuente’s case, the inspector general’s settlement account concerned the company’s own Medicare claims and records. The independent review then identified an overpayment that the company failed to return. The supplier’s records connect the request for public money to its handling of money already paid.

A person handling repayments may see what happens after someone challenges that payment. That account can help us understand the company’s decisions. Our work is to connect the claims, review findings and payment records with what the people inside the business know, so the case reflects how the operation actually worked.

Shreveport’s Failure Came Before the Review

Shreveport Prosthetics failed to engage an Independent Review Organization for its required claims reviews, while La Fuente’s reviewer identified an overpayment the company failed to repay.

What the Supplier Did After the Finding

The 2020 Journal of Forensic and Investigative Accounting paper A Forensic Accountant’s Guide to the Most Potent Federal Laws Used Against Healthcare Fraud explains that the False Claims Act can reach knowingly keeping money owed to the government, as well as falsely billing it. That brings the company’s handling of an existing payment obligation into the picture.

A billing insider’s account still matters after an overpayment is found. What the company learned and how it responded can be as important to understanding the conduct as the original claim. La Fuente’s integrity-agreement action shows a concrete point at which those questions arise: the reviewer identified an overpayment and the supplier failed to repay it.

For someone seeing a similar problem inside a health care business, we assess the claims, the review findings and the response together to determine what case the evidence supports. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What Happened Inside

If you know a prosthetics supplier submitted false Medicare claims or left an identified overpayment unpaid, speak to one of our Whistleblower Experts about what happened inside the business. We work with you to build the case around the claims and the company’s response, bring in healthcare fraud whistleblower lawyers who understand supplier billing, and remain your partners through the pursuit of a recovery.