Durable Medical Equipment (DME) Fraud
DME fraud: Medical fraud at the cost of the American people.
Whistleblowers are often the only way DME companies can be held accountable.
What is durable medical equipment fraud?
Durable Medical Equipment (DME) is any device that is primarily used to serve a medical purpose in the home and is only useful because of an illness or injury. This broad definition includes many different types of equipment – from bedpans to wheelchairs to oxygen – that are used to prevent and treat diseases or other conditions.
Telemedical DME suppliers are among the most common perpetrators of fraud and abuse in the health care industry, often through practices such as billing for medically unneccessarry equipment or for services that were never performed.
Common types of DME fraud.
Durable Medical Equipment (DME) is a term that can encompasses many devices used in patient homes for daily care and comfort, such as:
- Wheelchairs and walkers
- Oxygen supplies
- Blood glucose monitors and test strips
- Devices to treat sleep apnea
- Prosthetic limbs
- Medical beds
The government pays for these types of medical devices through health care programs like Medicare and Medicaid when a doctor deems them medically necessary. However, many practitioners take advantage of the system and defraud the government through false claims and billing.
Some of the most common ways DME fraud take place include:
- Billing for medically unnecessary equipment
- Billing for equipment or supplies that were never provided to patients
- Billing for services that were never performed, such as periodic maintenance, orthotic adjustments, etc.
- Billing for more expensive equipment than that which was actually provided to the patient (upcoding)
- Providing defective equipment to patients
- Providing equipment that was not ordered by a doctor
- Forging physician signatures
- Managing a dummy DME company making fraudulent claims using stolen information
The False Claims Act
The False Claims Act, 31 U.S.C. § 3729 et. seq., has roots tracing back to the American Civil War. This act allows individuals with information regarding federal government contractor fraud to bring suit on behalf of the federal government for return of the monies they received. This is often referred to as qui tam litigation.
The government relies on the FCA to combat contractor fraud – this act makes it easier for whistleblower plaintiffs to bring about cases, as they are protected and often rewarded significantly.
Fraudulent DME practices are illegal under the False Claims Act, which allows whistleblowers the right to protection and compensation for helping the government seek justice for fraud.
Protection & Rewards
The False Claims Act.
The False Claims Act ensures that any whistleblower who brings claims exposing government fraud is protected. The Anti-Retaliation provision in the False Claims Act establishes that an employee, contractor, agent, or any other type of whistleblower which is employed by the company at issue cannot be retaliated against, or threatened for retaliation, for their actions.
Protection against Retaliation or Harassment.
Retaliation could take the form of harassment, dismissal, demotion or disciplinary measures. Harassment could also include such behaviors as failing to renew the contract of a whistleblower, withdrawing certain privileges (such as access to training), or the loss of responsibilities (marginalization).
Billions have been recovered. Up to 30% awarded.
In 2023 alone, whistleblowers helped the government recover $2.68 Billion. For their courage and assistance, a whistleblower can be awarded 15% to 30% of the amount recovered in their case.
Frequently Asked Questions
Who investigates DME fraud?
The Office of Inspector General for the U.S. Department of Health and Human Services will often investigate reports of DME fraud together with the FBI.
How do I detect DME fraud?
Review all billing, treatment or appointment summary notes, and explanation of equipment provided. If you work for a healthcare provider, you may be told by your employer to bill for durable medical equipment that was inaccurate or not provided, or to change the coding when billing. This is against the law and should be reported.
What kind of evidence should I have before reporting DME fraud?
It is important to have concrete evidence of DME fraud before reporting it. While documentary evidence is not required, it is considered in many cases and can play a role in your case. Records of improper charges, emails stating fraudulent claims, or in-office memos can be helpful, however, there are important factors to consider before removing company documents. Our experienced qui tam attorneys can evaluate the evidence you have of DME fraud help with navigating the rules about disclosure that ensure your rights are protected.
Do I need to file a claim or can I just report the fraud?
Simply reporting DME fraud activities is often not enough to receive compensation for whistleblowing. You must formally file a claim in court and include evidence of the misconduct under the False Claims Act.
What happens if the government does not pursue the case?
Under the False Claims Act, the government can choose to take over the case, called “intervention,” or can decline to do so. Less than 15% of cases are intervened in by the government. However, this is often due to factors that are unrelated to the strength of the case, the amount of information brought by the whistleblower, or the nature or extent of the defense contractor fraud reported. You may have the option of pursuing the case even if the government declines to intervene in your case. We can help you evaluate this possibility during our consultation with you.
Reach out and take advantage of our free case evaluation.
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