Whistleblower Awarded $1.8 Million for Reporting Medicare Fraud

Mary Jane Wilmoth

Published On: May 18th, 2017

On April 25, 2017, the Department of Justice (DOJ) announced that Braden Partners, L.P., doing business as Pacific Pulmonary Services (PPS), paid $11.4 million to resolve allegations it violated the False Claims Act. California-based PPS furnishes stationary and portable oxygen tanks and related supplies, and sleep therapy equipment, such as Continuous Positive Airway Pressure, Bi-level Positive Airway Pressure masks and related supplies, to patients’ homes in California and other states.

A whistleblower, Manuel Alcaine, who is a former PPS sales representative, alleged PPS had submitted claims for reimbursement to Medicare and other federal healthcare programs for oxygen and related equipment supplied in violation of program rules, and for sleep therapy equipment supplied as part of a cross-referral kickback scheme with sleep clinics. The allegations dated to about 2004, when PPS began submitting claims to the Medicare, TRICARE and Federal Employee Health Benefits programs for home oxygen and oxygen equipment without obtaining a physician authorization, as required by program rules.

“This settlement demonstrates our continued pursuit of health care providers who take advantage of federal healthcare programs,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division. “We will investigate and take action against providers who cut corners and pay kickbacks.”

This settlement resolves the lawsuit Mr. Alcaine filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the government for false claims and to share in any recovery. Mr. Alcaine will receive $1.824 million of the recovered funds.