SuperCare Health: Alleged Billing for Ventilators Patients No Longer Needed or Used

In the SuperCare ventilator settlement, SuperCare Health agreed to pay $3,315,308 to resolve allegations that it billed Medicare and Medicaid for ventilator rentals patients no longer needed or used. A respiratory therapist who worked for the company brought the whistleblower case. The person seeing the patient could see something the monthly bill did not show.

What the SuperCare Ventilator Settlement Covered

The Justice Department announced the settlement on August 25, 2021. SuperCare, based in Downey, California, provided home respiratory services and durable medical equipment. Its agreement with the United States, California and Nevada resolved a False Claims Act case involving non-invasive ventilators supplied to respiratory patients at home in those states.

According to the government’s account of the lawsuit, SuperCare submitted or caused others to submit false claims between May 2013 and October 2019. The alleged problem was continued billing for rentals after patients stopped using or needing the devices. Medicare and Medicaid reimbursed the rentals monthly, with payment tied to the patient’s treatment needs.

Non-invasive ventilators deliver pressurized air into the lungs of patients with respiratory failure. Ventilators belong to Medicare’s equipment category requiring frequent and substantial servicing. Under the Social Security Act’s equipment-payment provisions, that category pays for rental month after month, without the rental cap and ownership transfer attached to capped-rental equipment. The clinical basis for that revenue has to keep up.

SuperCare’s alleged conduct left taxpayers paying for unused or unnecessary equipment. Under that allegation, the rental income continued even after the equipment stopped serving the patient. For an insider, that is a question about what happened after the equipment reached the home, and what the supplier knew when it kept billing.

The Respiratory Therapist Whistleblower in the SuperCare Ventilator Settlement

The whistleblower worked for SuperCare as a respiratory therapist and brought the qui tam case that led to the agreement.

A respiratory therapist’s view can connect the patient’s treatment to the supplier’s records. Device settings, usage records and home visits can show what is happening after delivery. The billing side shows whether the company continues charging for the rental. Those are different views of the same equipment, and the difference between them is where these cases become concrete.

What Other Respiratory Whistleblower Cases Show

In the Justice Department’s February 15, 2024 settlement announcement, Lincare admitted that it continued seeking monthly payments in some instances when it knew patients were not using the ventilators.

Oxygen Plus agreed to a settlement announced in October 2023 over allegations that it billed Medicare and Medicaid for home respiratory devices patients did not need or use.

What Evidence Is Needed to Report Medicare Fraud?

For ventilator rental billing, we work with insiders to connect the patient’s need and use to the supplier’s claims for the same rental period. Our whistleblower experts examine how the order, clinical record, therapist’s observations and billing history fit together. The patient’s care and the company’s payment records need to tell the same story.

Home-visit notes and usage records show what happened after the device arrived. Settings and maintenance observations can help explain how the equipment was being used. We work through those records with the employee who understands them, tracing when the supplier learned that use had stopped and what happened to billing afterward.

For a billing employee, the important connection may run in the other direction: a recurring claim continues while clinical staff are reporting non-use. The payment history makes the consequence visible. The clinical records explain why that claim deserves attention. We work with insiders to connect those decisions to the company’s knowledge and the government payments at issue.

What Is the Reward for a Medicare Fraud Whistleblower?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. The Justice Department announced that the therapist who brought the case would receive a share of the federal recovery.

You Know the Care and the Claims

If your home visits or billing work showed ventilator rentals continuing after patients stopped using the equipment, speak to our whistleblower experts about the rentals that kept billing. We build your strongest case with you and bring in healthcare fraud whistleblower lawyers who understand respiratory equipment billing. We stay beside you as your knowledge of the care and the claims becomes the foundation of the case.