According to the U.S. Government Accountability Office, Medicare spent approximately $9 billion on durable medical equipment in 2020. If a recipient’s doctor accepts Medicare, taxpayer-funded benefits include DMEs.
Patients may buy DMEs such as blood sugar meters and wheelchairs for 20% of the costs, as noted on Medicare.gov. Because of the potential for fraud, the government monitors companies supplying DMEs. Before accepting orders, new companies undergo an on-site review and must put up a bond to bid on contracts.
Fictitious companies contact patients to discuss DMEs
In some cases, a lack of oversight may result in bogus supplier orders. As reported by ABC Action News, Medicare receives fraudulent DME claims totaling hundreds of millions of dollars each year.
Florida’s seniors, for example, receive several mail orders for DMEs such as knee braces that they have no use for. Allegedly fictitious companies, however, file claims for them. A representative calls a list of Medicare patients on the phone and obtains their consent to receive DMEs.
Physicians may find themselves facing fraud charges
Claims for DMEs may also come through medical providers enrolled in the federal program. The federal Anti-Kickback Statute prohibits physicians from receiving remuneration.
The U.S. Department of Health and Human Services’ Office of Inspector General’s website notes that it qualifies as a federal offense to receive kickbacks such as by approving patients for supplies they do not need. Referring patients to receive medical supplies or services in exchange for a benefit may violate the AKS.
Allegations of accepting remuneration for prescribing DMEs may result in a lengthy government investigation. Officials may begin by scrutinizing a doctor’s billing practices, and the outcome may result in filing healthcare fraud charges. Strong legal counsel may assist an alleged offender during the investigation.
