DURABLE MEDICAL EQUIPMENT (DME) FRAUD
WHAT IS DURABLE MEDICAL EQUIPMENT (DME) 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. These providers are defrauding the government at the cost of the American people, and whistleblowers are often the only way DME companies can be held accountable.
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
These and other 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.
HOW WHISTLEBLOWERS CAN GET COMPENSATION FOR SEEKING JUSTICE
Whistleblowers with evidence of past or ongoing DME fraud may be able to collect substantial compensation for reporting these illegal activities. A federal case will often be launched to bring the responsible parties to justice for their crimes. If you’re prepared to seek justice for DME fraud, you need an experienced lawyer on your side. Price Armstrong attorneys have a wealth of experience successfully representing fraud whistleblowers. We’ll protect you from retaliation and abuse, helping you fight to get the justice and compensation you deserve.
Contact us for a free initial consultation and review of your potential case.
DME FRAUD FAQS
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.
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.
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.
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.
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 telehealth fraud reported. Some qui tam lawyers will not represent you or pursue your case if the government declines to intervene.
CONTACT US FOR A FREE CASE EVALUATION
If you have evidence of past or ongoing DME fraud, contact the attorneys at Price Armstrong. We can help you seek justice and protect your rights throughout the process. We represent clients nationwide with three offices in Birmingham, AL, Tallahassee, FL and Albany, GA. Complete a form, start a chat or call us today at (205) 208-9588 for a free initial consultation and review of your case. Let us fight for you – call now!
