On January 20, 2021, Florida Attorney General Ashley Moody announced a $40 million settlement between the state’s Medicaid Fraud Control Unit (MFCU), the United States Department of Justice, and other states MFCUs against April Healthcare Group Inc. and Apria Healthcare LLC.
The federal-state investigation arose out of a qui tam suit filed in the United States District Court for the Southern District of New York in 2017. Relators Benjamin Martinez, Jr., Connie Morgan, and Christopher Negrete alleged that Apria violated the federal False Claims Act and various state false claims statutes by submitting false claims to state Medicaid programs to seek reimbursement for non-invasive ventilator (NIV) rentals that Medicaid beneficiaries either did not use or medical professionals deemed not medically necessary from January 1, 2014 to December 31, 2019.
The investigation also found that routine physician visits to confirm individuals were following correct NIV procedures were not often maintained, and in December 2016, more than half were not completed. In 2017, an Apria executive informed a member of Apria’s executive leadership that the NIV clinical team believed a “meaningful proportion” of the home visits that should have been happening as part of Apria’s “baseline clinical policy” were not being done.