Durable Medical Equipment (DME) Fraud

While many cases of healthcare fraud concern billing practices for procedures, tests, and medications, allegations of fraud involving durable medical equipment are arising more frequently. This is especially true as the population of Michigan ages and the need for such equipment increases. If you are concerned about the possibility of being accused of fraud with respect to durable medical equipment, it may be a good idea to address the issue promptly in the interests of minimizing potential consequences.

A Michigan durable medical equipment (DME) fraud lawyer can assist with compliance issues, and with defending against any charges or allegations. When you work with a healthcare fraud attorney who understands medical equipment fraud, you gain an advocate who can help you protect your rights and your future.

The term durable medical equipment—or DME for short— could mean different things to different people. The federal government defines DME in 42 C.F.R. §414.202 as equipment supplied by a home health agency or provider that has the following characteristics:

• It is "primarily and customarily" used for a medical purpose, yet it is useful in the home
• It is expected to last at least three years
• It can withstand repeated use
• It usually serves no useful purpose unless someone is ill or injured

Equipment such as or similar to crutches, nebulizers, commode chairs, and blood sugar monitors qualify as durable medical equipment in the eyes of the federal government, as do larger pieces of equipment like hospital beds, power scooters, and wheelchairs. Medicare covers all these and many more types of DME, which a durable medical equipment fraud lawyer in Michigan can help further define and catalog.

Medicare Part B, also referred to as Medicare medical insurance, covers some costs associated with DME when it is considered medically necessary and when prescribed by a doctor for home use. Both the provider of the equipment and the doctor prescribing it must be enrolled in Medicare and follow all relevant requirements and standards. In many situations, providers must have a Certificate of Medical Necessity signed by a doctor before the federal government may be billed for DME.

Providers that accept "assignment" have agreed to accept the Medicare-approved amount for DME and may not charge in excess of this amount. Patients are often responsible for paying a certain portion and a deductible. Providers that do not accept assignment are not regulated in the amount they may charge.

Some providers of DME have gained a reputation for fraudulent practices, and that suspicion now carries over to other providers. In certain cases, providers may bill for equipment never provided or equipment maintenance never performed. They may also bill for equipment that is not considered medically necessary or that a patient is not eligible to receive.

Other types of fraud that could be alleged against a DME provider in Michigan include forging a doctor's signature on a Certificate of Medical Necessity, paying kickbacks to doctors for referrals, providing defective equipment, or billing for equipment that is more expensive than that which they actually provided.

Providers of DME may face liability for these practices under the federal False Claims Act. Suits alleging attempts at defrauding the government through fraudulent claims may be brought directly by the government or by private individuals acting as "whistleblowers" to expose fraudulent practices. No matter which type of fraud that a durable medical equipment provider is accused of, a well-versed Michigan attorney could review their allegations and champion their case.

Insurance billing is complicated, especially when it involves federal programs such as Medicare. A DME provider could make every attempt to comply with requirements and still commit a mistake. Even so, mistakes can be treated as attempts at fraud and civil or criminal liability may result.

A Michigan durable medical equipment (DME) fraud lawyer can provide assistance whether you are facing criminal fraud charges under 18 U.S.C. §1347, liability under another provision, or whether you just wish to put procedures in place to avoid allegations of fraud in the future. To learn more about how a DME fraud lawyer can help meet your needs, call for a consultation.