Medical Equipment Fraud Explained
Medical equipment fraud is a form of health care fraud, which may include fraudulent billing practices, illegal kickbacks, or other regulatory violations.
Durable Medical Equipment Fraud
Durable medical equipment is equipment that can withstand repeated use and serves a medical purpose for someone with an injury or illness. Examples of durable medical equipment include powered and manual wheelchairs, medical beds, oxygen equipment, and walkers.
Supply companies of durable medical equipment have recently been under heightened scrutiny by federal and state agencies. In fact, recently the Department of Health and Human Services Centers for Medicare & Medicaid Services adopted a rule requiring prior authorization for certain durable medical equipment as a condition of payment by Medicare.
The rule is aimed at reducing “unnecessary utilization and aberrant billing” by durable medical equipment suppliers. Although some medical supply companies have defrauded the government and insurance providers, many others have come under investigation because of simple errors in processing transactions.
Durable medical equipment fraud has serious consequences for the owners of these companies, including fines and prison sentences. Also, medical equipment fraud may constitute the basis for a Qui tam whistleblower lawsuit under the False Claims Act.
Types of Medical Equipment Fraud
Common types of fraud relating to medical equipment include:
- Billing for medical equipment or supplies that were never furnished to the patient.
- Providing or billing for a product that was no longer medically necessary or that was not ordered by the treating physician.
- Overbilling for medical equipment or supplies.
- Billing for a more expensive product than the one actually furnished to the patient.
- Altercating or fabricating wholesale invoices.
- Falsifying letters of medical necessity.
- Submitting claims for fictitious patients by using stolen social security numbers.
- Kickbacks from supplies to physicians for patient referrals.
- Violations of the rules regarding telemarketing by medical suppliers.
White Collar Criminal Defense Attorneys
In some instances, simple mistakes in the process of supplying a patient with medical equipment and supplies, or errors in billing, can cause problems with what began as a legitimate, legal transaction. The government may view these mistakes as fraudulent action and begin an investigation.
If you or your medical supplies company are under investigation for or have been charged with medical equipment fraud, you need a criminal defense lawyer who knows how to defend a complex medical equipment fraud case. Here at Ashley D. Adams, PLC we zealously defend all types of medical equipment fraud. We have the experience and skill to aggressively and effectively represent your legal rights. Contact us today to schedule a case evaluation.