False Claims for DME Are a Growing Form of Healthcare Fraud and Abuse

Healthcare fraud and abuse is an epidemic that takes many forms. One of the fastest growing types of healthcare fraud and abuse involves durable medical equipment (DME). Durable medical equipment is used to assist people with many different kinds of ailments in their residential environments, and provides support for both temporary and permanent conditions.

Unfortunately, many unscrupulous individuals in the healthcare field take advantage of people and commit healthcare fraud and abuse with DME. Types of DME (and DME that has routinely been used in healthcare fraud and abuse cases) include wheel chairs, back supports, prosthetics, orthotics, incontinent kits, and scooters—to name a few. Two of the most common types of DME healthcare fraud and abuse occur when a physician submits a false claim for DME never provided, or submits a claim for an inferior DME product—such as giving a patient Dr. Scholls inserts instead of a customized insert.

Healthcare fraud and abuse statistics relating to DME are staggering. According to the Department of Justice,whistleblower lawsuits related to DME have returned over $13 billion since the 1986 amendments to the False Claims Act.

All of the following situations may constitute healthcare fraud and abuse. According to the False Claims Act, some of the many ways DME healthcare fraud and abuse occurs is when claims are submitted for:
* DME provided prior to receiving a written order from the physician
* DME supplied when the written order is incorrectly completed by the physician
* DME that is not medically necessary
* DME that the patient did not receive
* Billing for a more expensive DME when a less expensive DME was provided
* Prescribing more DME items than are necessary for the needs of a patient
* Providing a DME that is of inferior quality or not cleared by the FDA
* DME that does not match the physician’s diagnosis
* DME returned but never credited back to account

DME Healthcare Fraud and Abuse: A Case Study
Noel Jhagroo, the former owner of a Houston-based DME company, pleaded guilty to defrauding Medicare by submitting nearly one million dollars in fraudulent claims. In most instances, the DME was medically unnecessary or was never provided to patients in the Medicare program. Mr. Jhagroo also pleaded guilty for submitting false claims to Medicare for medically unnecessary orthotic items, such as arthritis kits. He billed Medicare nearly $4,000 for each inferior kit, which included inexpensive and lightweight neoprene sleeves that typically didn’t even fit the patient.

This, of course, is just one instance of DME healthcare fraud and abuse. Fraudulent DME claims are rampant and growing all the time, and costs tax payers millions of dollars each year. There have, however, been steps taken in the right direction. For example, all DME suppliers must reapply as a licensed provider every year.

To prevent DME healthcare fraud and abuse, always check to see whether or not:
* DME provided prior to receiving a written order from the physician
* DME supplied when the written order is incorrectly completed by the physician
* DME that is not medically necessary
* DME that the patient did not receive

If you want to learn more about stopping healthcare fraud and abuse, visit www.TheIdentityAdvocate.com or call 310.831.4400.