Medicare provides durable medical equipment (DME) to those in need, but DME fraud costs billions.
If you suspect DME fraud in North or South Carolina, even if you’re not sure or you were involved, call us. We know how to protect you.
Reporting Durable Medical Equipment Fraud: What You Should Know
Durable Medical Equipment (DME) fraud is a pervasive and serious issue plaguing the healthcare system, costing taxpayers billions of dollars annually and compromising patient care. If you suspect DME fraud, you can play a crucial role in exposing these fraudulent practices and protecting both patients and the integrity of our healthcare system.
Durable Medical Equipment refers to reusable medical devices prescribed by healthcare providers to aid patients in managing medical conditions. DME fraud occurs when unscrupulous individuals, healthcare providers, or companies manipulate the Medicare, Medicaid, or TRICARE systems to profit illegally, such as through fraudulent billing or providing substandard equipment to vulnerable people.
Even if you aren’t sure what you’re seeing or you’re concerned you may have participated in the fraud, we know how to help you. We also know how to protect you and pursue a maximum reward on your behalf in a successful case.
Before you report your concerns to HR, call our experienced whistleblower attorneys for a free, absolutely confidential conversation. We can answer your questions and help you decide on the next best steps forward for you, so don’t hesitate to call 1-888-292-8852 or contact us online now.
What are examples of Durable Medical Equipment?
Durable Medical Equipment devices are designed to withstand repeated use and serve a medical purpose. Examples include:
- Wheelchairs and mobility scooters
- Hospital beds and support surfaces
- Oxygen equipment and supplies
- CPAP machines for sleep apnea
- Prosthetic devices and artificial limbs
- Orthotics and braces
- Nebulizers for respiratory treatments
- Blood sugar monitors and testing strips
- Walkers and canes
- Infusion pumps and supplies
What is Durable Medical Equipment fraud?
Patients who are on Medicare can get much of their durable medical equipment (DME) subsidized by the government. Medicare will often pay for it, so the patient doesn’t incur an out-of-pocket cost. That’s where greedy fraudsters come in with fraudulent claims for government funds.
Common DME fraud includes:
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Billing for equipment never delivered to patients |
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Providing unnecessary equipment or devices not medically indicated |
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Supplying substandard or outdated equipment while billing for new, top-of-the-line models |
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Upcoding or billing for more expensive items than actually provided |
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Falsifying prescriptions or medical necessity documents to justify billing |
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Offering kickbacks to healthcare providers for referrals or prescriptions |
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Billing for rental equipment after it has been returned/td> |
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Misrepresenting non-covered equipment as covered items |
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Forging patient signatures on delivery receipts |
DME fraud drains Medicare resources, potentially denying legitimate patients access to necessary equipment and compromising their quality of life. Moreover, it can lead to patient harm if inappropriate or faulty equipment is provided, potentially exacerbating medical conditions or causing new health issues.
DME fraud is responsible for a significant part of the estimated $60 billion lost to Medicare fraud each year.
Where does DME fraud happen?
DME fraud can occur in various settings, making it challenging to detect and combat. When you’re working or interacting with these diverse fraud landscapes, you may recognize these suspicious activities:
- Medical facilities: Unethical healthcare providers, including doctors, nurses, or administrators, may collude with DME suppliers to prescribe unnecessary equipment or falsify documentation. This can happen in hospitals, clinics, nursing homes, or rehabilitation centers.
- Telemarketing schemes: Fraudsters often target seniors through unsolicited phone calls, offering “free” medical equipment in exchange for Medicare, Medicaid, or TRICARE information. These calls may appear legitimate, using spoofed caller IDs or scripts that mimic official communications.
- Door-to-door sales: Some scammers go door-to-door in residential areas, particularly targeting retirement communities or neighborhoods with high concentrations of elderly residents. They may use high-pressure tactics or false promises to obtain Medicare, Medicaid, or TRICARE information or signatures.
- Mail fraud: Some unethical DME companies may send misleading advertisements or bills for equipment never ordered or received. These mailings often use official-looking letterheads and urgent language to deceive recipients.
- Pop-up storefronts: DME supply stores may appear in strip malls or shopping centers, collecting Medicare, Medicaid, or TRICARE information before disappearing. These operations often target areas with high senior populations.
- Community events: Fraudulent DME suppliers might set up booths at health fairs, senior centers, or community events, offering “free” health screenings as a pretext to collect Medicare, Medicaid, or TRICARE information.
- Social media: Increasingly, scammers are using social media platforms to advertise DME products, often using misleading claims or fake testimonials to lure potential victims.
Protect yourself and others: Spotting DME fraud
DME fraud not only costs taxpayers billions but also puts vulnerable beneficiaries at risk of receiving improper care or being denied necessary equipment.
Here are some DME fraud against the government red flags to watch for:
- Unsolicited offers for free medical equipment or supplies
- Pressure to accept unneeded equipment
- Bills for equipment never received or services not used
- Multiple bills for the same item or service
- Equipment that doesn’t fit or work properly
- Charges for rental equipment after the patient has returned it
- Medicare Summary Notices (MSN) showing unrecognized DME claims
- Attempts to obtain patient healthcare information through gifts or incentives
If you have insider knowledge of DME fraud, such as through your employment or business relationships, you can earn a significant reward for exposing fraud under the False Claims Act – up to 30% of the government’s recovery in a successful case.
Worried about retaliation? We know how to protect you:
How our experienced whistleblower attorneys can help you
Our dedicated team of whistleblower attorneys brings years of experience in healthcare fraud cases and can provide invaluable assistance throughout your journey by:
- Evaluating your case confidentially and determining its strength
- Helping gather and organize evidence to support your claims
- Filing your qui tam lawsuit under seal to protect your identity
- Working with government investigators to build a strong case
- Continuing with your case, if you agree, even if the government declines
- Negotiating for the maximum possible whistleblower reward on your behalf in a successful case
- Helping protect you from retaliation throughout the process
Don’t let DME fraud continue unchecked. Expose fraud on behalf of all taxpayers and possibly receive a life-changing reward. If you suspect DME fraud against the government, call us at 1-888-292-8852 or contact us online today for help, answers, a confidential discussion, and recommendations on what to do next.
Contact the Carolina
Whistleblower Attorneys
If you’re wondering if it’s a good idea to speak with a whistleblower lawyer about what you know, let us set the record straight.
- Corporate ethics hotlines can be risky and may lead to termination. If you’ve already done this, call us immediately.
- Your coworkers could be aware of the fraud – or complicit in it – and you should not talk to them about it.
- The first claim to be filed under the False Claims Act can proceed – if you’re not first, you’re at a serious disadvantage and may get nothing (another reason not to speak to your coworkers about it).
- A confidential discussion costs you a few minutes, but could save you time, stress, and money.
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