Apria May Have Overcharged Medicare by $103M
Apria Healthcare Group, one the nation's largest home health care providers, might have overcharged Medicare by as much as $103 million, according to federal investigators, the Los Angeles Times reports. The Times reports that Apria has been the focus of a series of overbillings investigations, including a federal probe that closed two years ago without filing any charges (Reckard/Ballon, Los Angeles Times, 7/17). Apria said the recent investigation is the result of "one or more" individual lawsuits filed on behalf of the government. The government has not indicated whether it will join the lawsuits, but "could reach a decision soon," the Journal reports (Rundle, Wall Street Journal, 7/17). A government audit released last week of 300 Apria files over a three-and-a-half year period ending in 1998 found $110,000 in billings that "lacked adequate documentation," the Times reports. Based on those findings, government lawyers "calculated" that Apria is "liable" for $103 million, and that figure could be tripled to $309 million under federal law. Once penalties are added, fines could total as much as $9 billion, Apria said. But the company said that it could have to repay "less that $10,000 in billings" from the audited sample (Los Angeles Times, 7/17). The Journal reports that the billing problems are "almost entirely record keeping errors," including missing ZIP Codes on claim forms and missing forms. However, the Journal reports that Apria found most of the missing certificates and gave them to the government. Apria maintains that the government used "sampling and extrapolation methodologies" in the audit that were "statistically flawed and legally problematic." Apria CEO Philip Carter said, "The company has no evidence of overbilling or billing for services that weren't provided. The government hasn't provided us with any substantiation for their $4.8 billion to $9 billion estimates" (Wall Street Journal, 7/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.