Venice medical company to pay up to $4.9 million in false claims case

A Venice medical equipment provider has agreed to pay up to $4.9 million to settle allegations that it violated the Anti-Kickback Statute and False Claims Act, according to the U.S. Attorney for the Middle District of Florida.

LiveCare provides remote patient monitoring for people with Type 2 diabetes through the use of glucose monitoring supplies. Two former employees who worked in durable medical equipment for the company, including one who was also a “health coach,” brought forward allegations in 2022 that LiveCare was billing Medicare for unnecessary services and receiving kickbacks for glucose monitoring supplies, according to the complaint. The business was also accused of unlawfully paying a marketing service for referrals of Medicare beneficiaries. 

The $4.9 million settlement resolves the allegations and there was no determination of liability, according to a statement from the U.S. Attorney for the Middle District of Florida.

According to the complaint, LiveCare operates a call center where some callers were instructed to “coerce elderly Medicare recipients and tell them that they need to order glucose monitoring machines and supplies, or they risk losing their Medicare coverage, even when the Medicare recipients tell the caller that they do not have diabetes."

In what authorities described as a “multi-level fraud scheme,” LiveCare would have other callers inform Medicare recipients their address was needed to mail them a new Medicare card, when in fact the address would be used to send “unneeded glucose monitoring machines and supplies to unwitting Medicare recipients,” the complaint says. 

Daily, each call center employee spoke to 100 to 150 Medicare recipients, according to the complaint, and LiveCare sought reimbursement from Medicare to which it was not entitled for “diabetes equipment, including monitoring machines, supplies, braces and diabetic shoes.” Anyone who declined the equipment was charged $28 by LiveCare, the complaint says.

The complaint alleges LiveCare Chief Medical Officer Dr. Pareena Bilkoo received a kickback for each prescription she wrote for glucose monitoring supplies.

“Violations of the Anti-Kickback Statute undermine the integrity of our healthcare system,” U.S. Attorney Roger B. Handberg says in a statement. “The United States Attorney’s Office for the Middle District of Florida will hold providers participating in the federal health care system accountable for these violations in order to preserve program funds and ensure the provision of appropriate services to patients.”

Patients were incentivized to use the glucose monitoring equipment by a $25 Visa gift card for testing for 16 days (patients had to use the equipment for 16 days before the company could bill Medicare, LiveCare told staff), according to the complaint. To further encourage them, LiveCare did not charge co-pays and offered a $100 gift card to those who tested their glucose for 90 days and had regular interactions with a “healthcare coach,” according to the complaint.

LiveCare’s “healthcare coach” program “extends the fraud,” according to the complaint. Coaches received limited training yet were instructed to wear scrubs so that people in the office or on video chats would be “duped into believing they are dealing with a healthcare professional,” the complaint says. Each coach carried a caseload of 150 patients and was instructed to bill seven hours a day to Medicare for remote patient monitoring, counting tasks such as letting a call ring for 10 minutes, the complaint alleges.

Although health care coaches were neither trained nor instructed to discuss weight loss with patients, the complaint says LiveCare falsified patient records to show weight loss occurred so it could bill for health coaching and Medicare Diabetes Prevention Program services. 

The two employees who filed the case against LiveCare in August 2022 were both terminated in July 2022 after one raised concerns among coworkers about fraud, according to the complaint. They brought the complaint against LiveCare under the qui tam (commonly known as “whistleblower”) provisions of the False Claim Act and may receive a portion of the settlement.

LiveCare's case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General.

“Our agency will continue to thoroughly investigate health care fraud, including the emerging area of allegations related to remote patient monitoring," Acting Special Agent in Charge Ricardo M. Carcas, of the Department of Health and Human Services Office of Inspector General, says in a statement. “Kickback schemes waste valuable Medicare funds and undermine the integrity of medical decision-making."