Reporting Durable Medical Equipment fraud (DME fraud)

This article addresses how to get a whistleblower reward for reporting Medicare fraud by durable medical equipment (DME) companies.

Why report durable medical equipment fraud (DME fraud)

Our healthcare system is in a crisis. One reason is that ten percent of Medicare billings are inflated or fraudulent. Durable medical equipment fraud (DME fraud) is a big culprit. When you report durable medical equipment fraud (DME fraud) you also help ensure that durable medical equipment is safe and necessary. Delivering or providing unnecessary medical equipment wastes Medicare funds and even limits the availability of medical supplies and equipment for those in need.

Durable medical equipment fraud (DME fraud) is on the rise, and includes fraudulent billing of all types of durable medical equipment such as wheelchairs, prosthetic devices, portable oxygen tanks, and orthotics, just to name a few.

Examples of ways durable medical equipment (DME) companies cheat and commit fraud

There are many fraudulent schemes by durable medical equipment (DME) companies. One durable medical equipment fraud (DME fraud) schemes consists of providing unnecessary equipment. Another Medicare DME fraud scheme is not supplying the medical equipment at all or providing it to a person not eligible for Medicare or Medicaid. Other durable medical equipment fraud (DME fraud) schemes include paying kickbacks or referral fees for patients. Still, other durable medical equipment fraud (DME fraud) schemes include upcoding or billing for a different and/or more expensive equipment than provided.

Each of these fraudulent schemes will be briefly described followed by how to report durable medical equipment fraud (DME fraud) and how to apply for a reward for reporting DME fraud.

Durable medical equipment fraud (DME fraud) scheme: unnecessary equipment

One common form of durable medical equipment fraud (DME fraud) is providing unnecessary equipment to Medicare recipients/patients. In order to bill Medicare or Medicaid for durable medical equipment (DME) the company must certify that it was medically necessary. It is not enough that the DME is convenient or useful, it must actually be medically necessary for the Medicare recipient to be reimbursed by Medicare. If the durable medical equipment (DME) company lies or provides false information about the medical necessity, it is considered durable medical equipment fraud (DME fraud).

In some instances, the equipment provided was not approved by the FDA. For instance, many types of equipment (as well as medical implants or medical devices such as pace makers or hip replacement parts) must be approved by the FDA before they can be billed to Medicare. Anytime a DME company uses an unapproved equipment or device, it is Medicare fraud.

Durable medical equipment fraud (DME fraud) scheme: not supplying the medical equipment

Another common form of durable medical equipment fraud (DME fraud) is billing Medicare for DME not actually provided. Some DME companies obtain names and addresses of Medicare recipients and bill Medicare for equipment it never sends. They know that Medicare does not audit or verify that the DME was actually delivered. Variations of this durable medical equipment fraud (DME fraud) scheme include providing the equipment to those not eligible for Medicare or Medicaid but billing the government.

Durable medical equipment fraud (DME fraud) scheme: paying kickbacks or referral fees for patients

Many durable medical equipment (DME) companies pay hospitals, doctors, nursing homes and other healthcare providers a finder’s fee or referral fee if they refer Medicare patients to them. Even though the Medicare or Medicaid recipient may need DME, it is unlawful to pay kickbacks or referral fees to gain new customers. Anytime kickbacks or referral fees are paid, it undermines the entire process because it clouds the judgment of the Medicare providers. It can cause healthcare professionals to certify medical necessity when they might not if they were not going to receive a referral, kickback or finder’s fee. Therefore, paying a referral fee or giving anything of value in exchange for a referral is considered Medicare fraud.

Durable medical equipment fraud (DME fraud) scheme: upcoding

Medicare reimburses durable medical equipment companies based upon the item provided to Medicare recipients. Medicare has a code system with all eligible DME listed. There are different rates for different models or types of durable medical equipment. The DME company must certify as to the code being used that reflects the actual DME provided. As you might guess, it is cheating to bill for a higher code or grade of equipment than that actually provided. Without the help of whistleblowers, this type of fraud goes undetected because the Medicare recipient actually may receive a power wheelchair or other DME, but the DME company bills for a higher priced or more expensive equipment than delivered.

Rewards for reporting durable medical equipment fraud (DME fraud)

The good news is that the government wants you to report durable medical equipment (DME fraud) against Medicare and Medicaid, and offers significant whistleblower rewards. To receive a reward for reporting Medicare durable medical equipment (DME fraud), you must scrupulously follow the procedures for reporting a DME company for cheating Medicare. Following the reward statute’s reporting requirement is also the best way to get Medicare to open an investigation.

The rest of this article addresses how to report durable medical equipment (DME fraud) and how to get a whistleblower reward for reporting durable medical equipment (DME fraud) against Medicare or Medicaid.

Tips for reporting durable medical equipment fraud (DME fraud)

Below are just two important tips for how to report durable medical equipment fraud (DME fraud).
First, you don’t call a hotline to report durable medical equipment (DME) fraud to get a reward. In fact, the reward rules prohibit paying rewards based on tips. Instead, the reward requirements mandate that you use an attorney for reporting durable medical equipment (DME) fraud.

It is important to carefully select your lawyer because he must strictly follow the exact procedures for you to get a reward for reporting durable medical equipment (DME) fraud. (Attorneys that handle DME fraud cases take cases on a contingency basis consisting of a percentage of any whistleblower reward.)

Second, your attorney must report the durable medical equipment (DME) fraud scheme in specific detail describing how the DME company defrauded Medicare. If you don’t report durable medical equipment (DME) fraud correctly, your application will be rejected just like 75% of other whistleblower applications. That is why it is key that you select an attorney with experience with durable medical equipment (DME) fraud cases.

How much reward for reporting durable medical equipment fraud (DME fraud)

The size of a whistleblower reward is determined by the amount Medicare recovers based on your allegations of durable medical equipment fraud (DME fraud). The reward is between 15% and 25% of what Medicare gets back from the DME company that is cheating or overcharging the government. Rewards in the tens-of-millions have been paid to whistleblowers for reporting DME fraud.

How to report durable medical equipment fraud (DME fraud)

This rest of this website (plus the whistleblower books authored by Mr. Hesch) take you step-by-step through the process of reporting durable medical equipment fraud (DME fraud) against Medicare or Medicaid and how to report durable medical equipment fraud (DME fraud) to get a whistleblower reward.

Mr. Hesch is experienced investigating durable medical equipment fraud against Medicare. He worked over 15 years in the Civil Fraud Section of the U.S. Department of Justice in Washington, D.C. handling Medicare fraud cases. He is available to review your case and help determine whether you should and how to report fraud against Medicare by DME fraud schemes.

The link below “Do I have a case” shows you how to ask Mr. Hesch to review your Medicare durable medical equipment fraud case and how to get a reward for reporting DME fraud.

The link below “Report Fraud” has more information regarding how to get a reward for reporting durable medical equipment (DME) fraud against Medicare or Medicaid.