Sleep apnea company pays $37.5M to settle kickback lawsuits
Source: AP
SAN DIEGO (AP) ResMed, a San Diego-based company that sells sleep apnea machines, will pay $37.5 million to settle allegations that it provided kickbacks to obtain customer referrals, federal prosecutors announced Wednesday.
The settlement covers five whistleblower lawsuits filed on behalf of the federal government. The lawsuits say that the company provided free services and equipment to medical equipment suppliers, sleep labs and other health care providers in violation of the federal False Claims Act.
Paying any type of illegal remuneration to induce patient referrals undermines the integrity of our nations health care system, Jody Hunt, head of the U.S. Justice Departments civil division, said in a statement. When a patient receives a prescription for a device to treat a health care condition, the patient deserves to know that the device was selected based on quality of care considerations and not on unlawful payments from equipment manufacturers.
ResMed didnt acknowledge any wrongdoing in the settlement but agreed to tighten controls on its pricing and sales.
Read more: https://apnews.com/40c41519c9dee750d9652230d53c8a4b
Guess what brand my machine is!!!
CurtEastPoint
(18,650 posts)CanonRay
(14,104 posts)In health care
Hekate
(90,714 posts)The CPAP itself serves a useful function.
Initech
(100,080 posts)These people are the ones who provided my machine, and they're absolutely ruthless. I want them to go away.
IronLionZion
(45,453 posts)Customers should get some of that settlement But I suppose we're all taxpayers anyway.
CountAllVotes
(20,876 posts)I told them I did not want one of these things because it would frighten my cats!
I meant that!
Lying scum!!!!
Kali
(55,014 posts)and it could save your life. might want to rethink PAP treatment.
AZ8theist
(5,475 posts)Sorry, but you're worth more than your cats.
truthisfreedom
(23,148 posts)Is a massive racket. $1000 for a plastic machine that is sold by the tens of thousands? Its a brilliant and nearly silent machine but its obviously a billion dollar racket.
mopinko
(70,127 posts)yes, the ones from 20 years ago.
Algernon Moncrieff
(5,790 posts)A friend got one about 15 years ago and paid twice that for a reconditioned unit.
I too have an AirSense 10 and like it. It's made a difference in my quality of sleep to be sure.
AZ8theist
(5,475 posts)But the cost of the machine, while pretty high, i don't think is the real scam. It's the cost of the replacement items. Masks, hoses, reservoirs, filters...that shit is WAY overpriced, IMO.
keithbvadu2
(36,828 posts)Prescription only... price up a lot in the last few years.
Overpriced.
Algernon Moncrieff
(5,790 posts)I'm going to change company names here to keep DU out of hot water, but the blanks are easy enough to fill in.
I have health insurance with a company we'll call "Insurer." I described some symptoms to my GP, who is part of a State University Medical Network. Normally, the State University Medical Network prefers an in-house sleep study, followed by prescribing any necessary equipment and then the patient picks a local provider -- usually someone with an RT (respiratory therapist) that helps with mask selection, sizing, etc. But Insurer uses a 3rd Party Administrator for all of the aspects of their Sleep Disorder patients. We'll call them "TPA." TPA immediately says "No!" to the in-house study, and instead has me do a home study. I do that. State University Medical Network reads the study, and says I have "Severe Obstructive Sleep Apnea." TPA works their deal like this: I can't select a provider or a durable medical equipment dealer. They have a deal with a well-known National DME Provider (DME = durable medical equipment) that I'm forced to use. TPA bills me monthly for the CPAP on a rent-to-own deal, and I have to agree to be spied on - to have the device wirelessly report that I'm using it for 4+ hours per night or Insurer won't cover. National DME Provider ships the CPAP right away - but no fittings; no choice of masks; no lesson from an RT. I'm directed to links to online instructional videos. As part of being spied on, there is a phone app that reports on how you are doing. It kept saying I was having too many incidents during the night, and it was underreporting my use time. I had to call a lot of people to finally get to the local branch of National DME Provider and meat with a live RT. To be fair, she was helpful and got me a new mask that solved the problem. However, when it came time to order new masks (more on that presently), they wanted to send the old-style mask, not the one I'd been switched to.
So once you get the ResMed, you then see the full extent of how this scam works. For those that don't own a CPAP, there is the machine (lasts 5 years +/-), but there are also a lot of parts - a humidifier tank that holds water that humidifies the air you breathe; the tubing (which has a heating element); the mask; the stretchy cloth thing that holds the mask to your head. Everything that is not the machine gets replaced. National DME Provider makes its money by arranging frequent replacement intervals with Insurer and rates negotiated by TPA. So I get a call saying I am eligible to order new masks, new hose, new filters, etc. If I say "yes" (and why wouldn't I - it's getting billed to Insurer, right?) National DME Provider sends me the stuff. But then TPA bills me - generally for about 20% of what National DME Provider charges Insurer - and they robocall religiously. And they also send emails trying to sell me a SoClean (boy do they want to sell me a SoClean - ~350, in case you were wondering). I've come to find out some of this stuff is available on Amazon for about what my co-pays are. I also own the unit now, so if I want to go to a local DME shop, I am free to do so. The rub is I won't get reimbursed by insurance, but if I get to see an RT, get better advice on what masks to buy, etc. it's worth it to me.
Sanders talks about the Pharma companies and the For-profit insurers being the guilty parties for high health care costs. I have to disagree - it's the whole damn lot of them. The doctors, the drug stores (they just did a story here on CVS billing Medicare 10x what a local pharmacy was billing for the same drug), the hospitals, the DME providers, and the administrators (who are supposed to be controlling costs) all have their hands in our pockets.
AZ8theist
(5,475 posts)Cigna?
And some third party company called Comprehensive or some such shit?
Your post is right on the money.
EXACTLY what happened to me. Fortunately, I recognized the scam early, and started to shop on line for cheaper supplies. Stopped using my insurance and just purchased supplies outright. But thanks for an EXCELLENT post detailing the whole can of worms. Great job.
Algernon Moncrieff
(5,790 posts)And I thank you for your thanks, and I'm glad you too found cheaper stuff. I hope the CPAP is doing well for you!
JohnnyRingo
(18,636 posts)It seems like a lot of people I know suddenly have apnea. It's true I'm older, but still it's like the first thing they want to test for. I don't doubt doctors and their families get a lot of trips to Disney World these days.
You wouldn't believe how much pressure I'm getting from my doctor. I don't snore or have any other symptoms, but they're insisting I be tested. I already did it once and now they want a second try, claiming I "didn't sleep enough". I told them I don't want it, but they won't accept that for some reason.
NutmegYankee
(16,199 posts)I began to suspect I had it, and requested a sleep study in my 30s. Nurse at sleep clinic I was referred to checked me out and ruled I needed the "in-house study" and not a home study based on risk factors. The full study found severe sleep apnea. It changed my night big time, and my mornings, as coffee consumption went way down.
Kali
(55,014 posts)you may be correct - I wonder how many people who even ask get told they don't need therapy (like for mental health - who ever gets turned down by a shrink? LOL)
but this was not recognized very often a couple of decades ago, so it is natural for a certain boom in diagnoses.
Algernon Moncrieff
(5,790 posts)My wife suffered with mu snoring for 30 years. She nursed me after an accident requiring my knee to be rebuilt in early 2018. I vowed to do something about it. I got checked out, and I was diagnosed with severe sleep apnea. Got the CPAP. No more snoring.
Subsequent to that, I dropped 90+ lbs.
nitpicker
(7,153 posts)James48
(4,436 posts)Made a tremendous improvement in my health almost immediately. I love my ResMed 10 and Ive never paid a penny out of my own pocket through VA.