Medicare fraud can occur when durable medical equipment is inappropriately dispensed or prescribed. Doctors order and use medical devices, including everything from wheelchairs to x-ray machines, to help patients. Using these items without following federal and state guidelines might constitute fraud.
There are different ways that DME fraud happens, some purposeful and some not. Some examples include:
Medical device companies can blatantly forge a physician’s medical necessity determination, but sometimes companies commit fraud less obviously by enrolling patients in automatic refill programs without verifying that there is an ongoing need for the equipment.
A supplier may commit fraud by selling medical equipment that is defective or otherwise does not meet FDA standards or regulations. The FDA provides Good Manufacturing Practice regulations to protect patients from substandard equipment.
The False Claims Act prohibits certain payment arrangements, such as payments that include kickbacks, self-interest or fee-sharing between suppliers and care providers.
Marketers can only promote DME for uses approved by the US Food and Drug Administration; promoting products for off-label or unapproved uses is considered fraudulent.
Employing unlicensed technicians to provide medical treatment with or dispense DME can violate state licensing requirements.
Providing DME to unlicensed facilities can violate state law. In order to lawfully bill for DME, the facility must appear on state enrollment records and comply with relevant licensing requirements.
The healthcare industry is vast, and new rules and regulations appear seemingly every day. Remaining compliant with the law regarding durable medical equipment is a critical facet of any medical practice.