DME Billing Fraud Whistleblower: Crown Medical Solutions

What the Crown Medical Solutions Settlement Tells Us About DME Billing Fraud

Crown Medical Solutions LLC and its owners, Michelle and Philanzo King, agreed to pay $825,000 to resolve False Claims Act allegations that they submitted false claims to Medicare — a settlement that illustrates why DME billing fraud whistleblower cases remain an active federal enforcement priority. The settlement was based on the defendants’ ability to pay, and no determination of liability has been made. Every False Claims Act matter is different; results depend on the specific facts of each case, and no similar outcome is implied.

According to the Department of Justice, from November 1, 2017 through April 30, 2019, Crown and its owners allegedly billed Medicare for durable medical equipment — including knee braces, heel stabilizers, and back braces — that was either not medically necessary or not properly prescribed by a physician. The case was filed in the Northern District of Georgia and handled jointly by DOJ’s Civil Division Commercial Litigation Branch Fraud Section and the U.S. Attorney’s Office for the Northern District of Georgia. As Assistant Attorney General Brett A. Shumate stated in the September 21, 2026 announcement, “The Department of Justice is committed to fighting healthcare fraud and holding accountable those who exploit federal healthcare programs for personal profit.”

How a Whistleblower Brought This Case Forward

Karen Martinelli filed the qui tam action captioned United States ex rel. Martinelli v. Crown Medical Solutions, LLC, et al., No. 1:19-cv-01660 (N.D. Ga.), and as part of the resolution she will receive approximately $123,750 of the settlement amount. Every False Claims Act matter is different; results depend on the specific facts of each case, and no similar outcome is implied.

A qui tam action is a lawsuit that a private party — called a relator — files on behalf of the United States. Under 31 U.S.C. § 3730(b), a person may bring a civil action for a violation of section 3729 for the person and for the United States Government. The relator’s access to internal billing records, order documentation, or day-to-day operations is often precisely what gives the government the evidence it needs to investigate and resolve a case. Individuals who believe they have observed similar conduct may have standing to file a qui tam action under the False Claims Act — but timing and proper procedure are critical, and consulting an attorney experienced in False Claims Act matters before acting is important.

What Conduct May Constitute DME Billing Fraud Under the False Claims Act

31 U.S.C. § 3729 is the governing liability provision for false or fraudulent claims submitted to the government. The allegations in the Crown Medical Solutions matter offer illustrative — not exhaustive — examples of the conduct that may give rise to False Claims Act liability in the DME context.

This section is informational and does not constitute legal advice about any specific situation.

• Claims submitted without a valid physician prescription. The government alleged that Crown billed Medicare for knee braces, heel stabilizers, and back braces that were not properly prescribed by a physician — meaning the required documentation may not have been in the file at the time of billing.
• Billing regardless of medical necessity. The allegations include billing for DME that was not medically necessary, suggesting that clinical justification may not have driven the decision to submit claims.
• Documentation that does not reflect a genuine clinical evaluation. When paperwork appears to be created after the fact or does not correspond to an actual treating physician’s order, it may signal that the billing process has been separated from legitimate patient care.
• A pattern of billing across large numbers of beneficiaries. Billing the same categories of items — such as back braces or knee braces — across many beneficiaries without individualized medical review can be a marker that enforcement agencies look for when identifying potential fraud schemes.

Who May Be Positioned to Recognize DME Billing Fraud

The Crown Medical Solutions matter demonstrates that proximity to the billing process — not seniority or job title — is often what gives an insider the information needed to support a qui tam filing. A range of roles within the DME supply chain may place an individual in a position to observe the conduct described above.

• DME company employees with access to billing records or order documentation who can compare what was billed to what was actually ordered and delivered.
• Billing department staff who process or review Medicare claims and may observe patterns of submission that do not correspond to physician orders on file.
• Employees at physician offices that sign off on DME orders and who may be aware that signatures are being obtained without a genuine clinical evaluation.
• Staff in healthcare staffing or referral arrangements that facilitate DME orders and who may observe that referrals are being generated without regard to individual patient need.

What the False Claims Act Provides for Whistleblowers Who Come Forward

Under 31 U.S.C. § 3730(d), the False Claims Act provides that a relator in a case in which the government intervenes shall receive at least 15 percent but not more than 25 percent of the proceeds of the action or settlement, depending on the extent to which the person substantially contributed to the prosecution of the action. In a case the government declines to intervene in, the relator may receive between 25 percent and 30 percent of the proceeds. Karen Martinelli will receive approximately $123,750 from the $825,000 Crown Medical Solutions settlement. Every False Claims Act matter is different; results depend on the specific facts of each case, and no similar outcome is implied.

• Retaliation protections. 31 U.S.C. § 3730(h) provides protections for employees, contractors, and agents who are discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against because of lawful acts taken in furtherance of a False Claims Act action or in efforts to stop a violation.
• First-to-file considerations. The statute’s first-to-file rule means that the first qualified relator to file generally has priority. Anyone who believes they have observed DME billing fraud should consult with an attorney experienced in False Claims Act matters before taking action.
• Actual share depends on the facts. The law provides for these ranges, but the actual share in any case depends on the specific circumstances, including the extent of the relator’s contribution to the prosecution.

If practices like these look familiar from your own workplace, you can discuss what you have seen with a Price Armstrong attorney confidentially and at no cost. Call (888) 670-9542 or use the secure evaluation form below.

If practices like these look familiar from your own workplace, you can discuss what you have seen with a Price Armstrong attorney confidentially and at no cost. Call (888) 670-9542 or use the secure evaluation form below.

Frequently Asked Questions

What is DME billing fraud under the False Claims Act?

DME billing fraud, as illustrated by the Crown Medical Solutions allegations, generally refers to submitting claims to Medicare for durable medical equipment — such as knee braces, heel stabilizers, or back braces — that was not medically necessary or not properly prescribed by a physician. Under 31 U.S.C. § 3729, knowingly presenting a false or fraudulent claim for payment to the government may give rise to False Claims Act liability.

How much can a DME billing fraud whistleblower receive?

Under 31 U.S.C. § 3730(d), a relator in an intervened case may receive at least 15 percent but not more than 25 percent of the proceeds; in a declined case, between 25 percent and 30 percent. In the Crown Medical Solutions matter, relator Karen Martinelli will receive approximately $123,750 from the $825,000 settlement. The actual share in any case depends on the specific facts and the relator’s contribution. Every False Claims Act matter is different; results depend on the specific facts of each case, and no similar outcome is implied.

Who can file a DME billing fraud whistleblower lawsuit?

Under 31 U.S.C. § 3730(b), a person may bring a civil action for a violation of section 3729 for the person and for the United States Government. In practice, cases like Crown Medical Solutions show that DME company employees, billing staff, physician office employees, and others with direct knowledge of billing practices may be positioned to file. Proximity to the billing process — not title or seniority — is often the key factor.