Presented an in-depth analysis of a company's ethical failures and a discussion of of policy changes and other recommendations for solving these ethical issues to committee of notable business professionals.

1. Transitions for a
Better Tomorrow
Justin Andrews, Julie Clark, Kyra Miller, Coralei Neighbors, Ian Smith

2. Associate-Customer
Relations

3. “Lincare since 2003 billed government health programs
including Medicare for oxygen equipment and tanks even
when customers did not use or require them, fabricated
customer oxygen orders and improperly waived
consumer copayments and deductibles … paid kickbacks
to physicians and their families to refer patients by
providing them oxygen and supplies for free.”
Long Term Issues
Nate Raymond, Health News, JUNE 27, 2017

4. ● Billing Errors
○ Physicians inaccurately estimating length of care
○ Billing clients for equipment that wasn’t delivered
● Unethical Marketing Ploys
○ Offering free products, kickbacks, and waived fees
and/or deductibles
Main Issues

5. ● Client Surveys
○ Surveys incentivized with discounts on future care
○ Very specific so issues can be located at the core
● Sales Teams
○ Teams keep each other accountable for their actions
● Biannual Ethical Training
○ Quizzes to check retention and understanding of
knowledge
Solutions

6. Going
Electronic

7. What Went Wrong?
“According to the lawsuit, Lincare since 2003 billed government health programs, including
Medicare, for oxygen equipment and tanks even when customers did not use or require them,
fabricated customer oxygen orders and improperly waved customer copayments and deductibles.
The company also paid kickbacks to physicians and their families to refer patients by providing
them oxygen and supplies for free, the lawsuit said. In court papers, Lincare said it followed various
regulations and said the lawsuit was at most challenging “garden variety” billing errors.”
“There is evidence of other issues within Lincare. One issue might be lax policy promotion and
enforcement. In February of 2016, Lincare was ordered to pay a fine for HIPAA violations. An
Office of Civil Rights (OCR) investigation began after a report that in transitioning between homes,
an employee left behind sensitive protected health information for 278 patients.”
● Document Fabrications
● Kickbacks
● HIPAA violations
● Billing Errors

8. Recommendations
● Tablets:
○ Upfront Cost vs. Over Time
■ 2-3 clinicians/site
■ 1000 sites
○ Electronic vs. Paper - How much?
■ 1 employee ~~ 10,000 sheets/year
■ ~14,000 employees
■ ~$25/500 sheets
○ Storage Differences
■ Cloud vs. Mainframe

9. Recommendations
● Safety of Personal
Information
○ Electronic Signature
○ Timing Notices
○ Geographical Locks
● Customer Age Discrepancies
■ Youth vs. Elderly
● Customer Application:
○ App
■ Brightree -
$38/month/device

10. Transparency

11. Breach of Fiduciary Duties
● Failure to shop the company
● Failure to disclose information
“It was an acquisition that some challenge as a breach of fiduciary
responsibility to Lincare stockholders given the perceived lack of effort to
search for a better deal and concerns over whether the company was being
transparent in pursuit of the deal.”
Lessons for Lincare, MARCH 21, 2018
● Lack of transparency
● Negligence to M&A process

12. Board of Directors
Linde Group BOD Appointments
August 13, 2012
● Jens Luehring
● Patrick Murphy
● Björn Schneider
● Mark Weller

13. Recommendation: Board of Directors
● Lack of ethical guidance
○ Inattentive service
● Insufficient code of ethics
● Forced resignation
○ Replaced by July 1

14. Lincare
Linde Group

15. Who is really responsible?
● Which company? Which employees?
○ Both Lincare and Linde Group share responsibility for the
continued ethical failures of the company
■ Lincare = responsible for all of the past ethical failures that set
poor ethical standards
■ Linde = responsible for failing to take the proper steps to fix these
ethical problems and set proper standards
○ For both companies, it is the high-ranking employees
(executives) that should be held responsible for these ethical
failures, rather than the sales reps of the company

16. High to Low
● Lack of ethics of each company’s officials:
○ first affected the ethical decisions made at the top by
leaders
○ then trickled down into the ethical views and behaviors
of the lower-ranking employees
● Result: both employees and leadership acted in unethical
manners

17. Linde Integrity Line
● A key component of The Linde Group’s compliance program is the
Linde Integrity Line, “a global whistleblowing system”[1]
○ Offers employees and stakeholders with a system in which they can
anonymously report any issues or suspected violations they may have
so that Linde can “identify and deal swiftly with any misconduct”[2]
● Procedure:
○ 1) Each report is investigated
○ 2) When deemed appropriate, it is forwarded to the Linde Integrity
Committee for examination and determination of “further courses of
action”[1]
○ 3) The confidentiality of reports and protection of data is ensured
throughout this entire process Integrity Line, Linde Group, JUNE 27, 2017

18. The Spectra Gas Case
Oct. 2006: Linde acquired Spectra Gases, Inc.
Nov. 2006-Dec. 2009: “Spectra executives agreed to share the profits earned from the
equipment sale with NHTC officials in return for the officials' assistance in ensuring Spectra
was selected as the purchaser. The Spectra executives formed two companies through
which they made the equipment purchase and funneled bribes disguised as service fees to a
management company owned by the NHTC officials. In all, the Spectra executives funneled
75 percent of the profits generated by the boron column to the NHTC officials.”[1]
Jan. 2010: Linde discovered the corruption and began investigation only after dissolving
Spectra and becoming its successor in interest
● Shows a high level of negligence on Linde’s part
Covington, Holland & Knight, JUNE 21, 2017

19. New Management

20. ● New CEO, Kristen Hoefner
○ March 2015
● Negligence once in power
New Management

21. “In February of 2016, Lincare was ordered
to pay a fine for HIPAA violations. An
Office of Civil Rights (OCR) investigation
began after a report that in transitioning
between homes, an employee left behind
sensitive protected health information for
278 patients:...” [1]
New Management
Lessons for Lincare, MARCH 21, 2018

22. “There are also signs of potential concerns about an
unethical environment from internal stakeholders. As of
October 2017, Glassdoor had 538 reviews of Lincare
with an overall rating of 2.0 on a five-point scale. Only
21% would recommend the company to their friends and
only 36% approve of the CEO.”[1]
New Management
Lessons for Lincare, MARCH 21, 2018

23. Working at Lincare Holdings, MARCH 23, 2018

24. Pieces of a Puzzle

25. ● Linde Group has 3 major divisions, over 600
companies[1] in 100 countries worldwide, and around
58,000 employees[2]
● Ownership of many companies could have leaded to
a profit driven environment where they could not
oversee all of its companies
Pieces of a Puzzle

26. Pieces of a Puzzle
A. Malas, Sinterflex, MAY 18, 2018

27. ● Lack of care for the lower level employees
“Before Linde took over Lincare was a good company to
work for. Currently employees can expect a severe lack
of training, to be given different answers daily on how
something should be done, unfeasible workloads,
outdated computer system, everything is top secret and
management is continually dishonest with employees…”
- Current Employee (8 years)- Spokane, WA [1]
Pieces of a Puzzle
Lessons for Lincare, MARCH 21, 2018

28. Recommendations: Big Picture
Unethical Marketing Ploys
Billing Errors
Document Fabrication
Kickbacks
HIPAA Violations
Higher-Level Negligence
Whistleblowers
Client Surveys
Sales Teams
Biannual Ethical Training
Going Electronic
Resignation of the BOD
CEO Performing Correction
Correcting Pre-existing
Database (Integrity Line)
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