One common area of health care fraud that affects Medicare, Medicaid, Tricare, and other federal government benefit programs is durable medical equipment (DME) fraud. Federal authorities may accuse you and your business of fraud concerning prescriptions for DME, which may cause losses to the federal government.
There are several variations of DME fraud, which may include giving or receiving kickbacks, or payments in exchange for patient referrals, prescribing DME that is not medically necessary, or forging claims for DME that patients never receive. The penalties for any DME fraud are severe and may stem from the violation of several federal health care fraud statutes.
If federal authorities are investigating you for possible DME fraud, consider seeking legal advice from a Grand Rapids durable medical equipment (DME) fraud lawyer right away. A hard-working health care fraud attorney can defend you against allegations of DME fraud and protect your right throughout any civil or criminal proceedings.
Defining Durable Medical Equipment (DME)Durable medical equipment, or DME, consists of durable items, medical supplies, and medical products for use at home that shares the following characteristics:
For programs like Medicare or Medicaid to cover DME, a physician must certify that the DME is medically necessary. The physician then orders the DME through a DME business or supplier, who in turn files a claim with the benefits program to procure payment for the DME.
Some typical examples of DME may include wheelchairs, motorized scooters, walkers, hospital beds, dialysis equipment, canes, diabetic shoes, and body braces. If federal authorities allege that DME suppliers or companies have committed health care fraud, they might benefit from consulting a durable medical equipment (DME) fraud lawyer in Grand Rapids.
DME Fraud in Grand RapidsOne potential DME fraud scheme occurs when DME businesses illegally compensate physicians in exchange for more referrals. This violates the Anti-Kickback Statute, listed in 42 U.S.C. §1320a-7b, which prohibits medical and DME providers from intentionally trading compensation for referrals that will result in reimbursement from federal benefits programs. This may lead to referrals for DME that are not medically necessary, which also violates the False Claims Act (FCA), or those that benefit businesses in which physicians or their immediate family members have a financial interest, which violates the Stark Act.
Another possible violation of the FCA involves DME companies that falsify or forge physician certifications to claim reimbursement for DME unlawfully. These businesses also might violate the FCA by submitting fraudulent claims for DME on behalf of non-existent or “ghost” patients to obtain compensation to which they are not entitled, or on behalf of real patients who never received the DME.
To get compensation from federal benefits programs for DME, companies also must comply with various regulations and certify that they have done so with each claim that they submit to these programs. As an example, some states require that DME technicians be licensed to fit or dispense certain types of DME, and federal benefits program payments are conditioned on compliance with state licensing requirements. For any accusations related to DME fraud, businesses may find it beneficial to speak with a durable medical equipment (DME) fraud attorney in Grand Rapids.
Work with a Grand Rapids Durable Medical Equipment (DME) Fraud AttorneyWith health care costs steadily rising, federal government programs also are experiencing tremendous expenses. Consequently, the federal government is continually monitoring health care providers for evidence of fraudulent health care claims.
A Grand Rapids durable medical equipment (DME) fraud lawyer can be an invaluable resource as you are defending yourself against accusations of health care fraud involving DME. With legal experienced and knowledge on your side, you could place yourself in a better position to defeat the charges against you. Call today to schedule an initial consultation.