Durable medical equipment fraud has become a force in the swindling of funds from the Medicare and Medicaid programs.

The major players work at equipment supply companies and medical offices. Do you suspect that a federal investigation for DME fraud is coming to your office?

About DME fraud

Durable medical equipment fraud involves the needless ordering of medical supplies or equipment such as wheelchairs, crutches, oxygen equipment or diabetic blood-testing strips in order to fraudulently bill Medicare and Medicaid for payment. Some DME fraud schemes are elaborate and involve many people including doctors, pharmacists and medical equipment suppliers.

Examples at home and abroad

In 2019, federal authorities charged 24 people in several states, including Florida, in one of the largest DME fraud schemes ever uncovered in the U.S. The participants were receiving kickbacks and bribes for referring orders to medical equipment providers resulting in $1.2 billion in losses for the government. However, DME fraud is not confined to the U.S. In another example, kickbacks were also involved in phone calls to Medicare beneficiaries, which originated at call centers in Latin America and the Philippines. Callers pushed free medical equipment, such as back or knee braces. The orders received went to DME suppliers who subsequently billed Medicare, eventually resulting in losses to the government of $1 billion.

How an investigation proceeds

A federal investigation for an illegal activity such as DME fraud proceeds slowly so as not to arouse suspicion that could shut the activity down. It is not unusual for this to take years. At some point, however, subtle red flags may appear. The moment you suspect an investigation, it is time to begin work on a defense strategy.

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