DME Conviction & Fraud Settlement Reported

DME Conviction & Fraud Settlement Reported

Durable medical equipment (DME) fraud continues to be one of the top kinds of fraud reported to our California Senior Medicare Patrol (SMP). We receive many cases where beneficiaries disclose personal information to callers offering them braces. In other cases, beneficiaries respond to TV commercials advertising braces to alleviate pain and later receive a low quality brace or no brace at all. In all types of cases, Medicare often pays hundreds of dollars for DME that is medically unnecessary and/or DME that isn’t rendered. Recently, we’ve also heard of scammers calling beneficiaries and telling them that a UPS package is waiting for them, and to accept it, they must give their personal information. These examples just represent a taste of the multiple types and proliferation of DME scams out there.

Below is a summary of two recent Department of Justice (DOJ) cases regarding DME fraud. One is a conviction and the other is a settlement. In general, to prevent this type of Medicare fraud and protect Medicare benefits, we urge beneficiaries to guard their Medicare cards and remind them that if they are in need of any DME, they should consult with their doctor first to obtain medical necessity. To report fraud, call our California SMP at 1-855-613-7080.

Two separate DOJ cases involving durable medical equipment (DME):

In the first, a federal jury found the owner of a medical equipment company guilty of multiple counts of Medicare fraud and identity theft. The scheme involved items that were never provided to patients and never ordered by a physician. She submitted thousands of false claims, fabricated patient files, and falsified prescriptions from doctors for items such as heavy-duty wheelchairs while providing much cheaper standard wheelchairs to patients. Read a Department of Justice press release for more info.

In another case, a company agreed to pay more than $1.6 million to settle False Claims Act allegations. Complaints were based primarily on allegations surrounding the company’s use of a telemarketing scheme to sell knee and back braces to Medicare beneficiaries. The United States alleged that the company violated Medicare’s prohibition against telephone solicitation of covered products to beneficiaries. For more info, read a Department of Justice press release.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.