Durable Medical Equipment Fraud

Serving Clients Nationwide

Durable medical equipment (DME) fraud continues to be a significant source of fraud affecting insurers, government agencies, and patients who rely upon this equipment for their ongoing health needs.  Durable medical equipment (also known as durable goods, medical supplies and home care products) is defined as items or appliances that:

• Can withstand repeated use
• Are primarily and customarily used to serve a medical purpose
• Are most useful to ill, injured or disabled people
• Are appropriate for home use, and/or
• Are necessary for one or more daily living activities.

To be covered under Medicare and Medicaid, a physician must order the equipment through a “Certificate of Medical Necessity” (CMN) which is sent to a supplier who fills the order and can then file a claim with the appropriate state or federal healthcare program.

Types of Durable Medical Equipment Fraud

Common types of fraud relating to DME often involve versions of the following scenarios:

• Billing for equipment or supplies that were never provided
• Billing for products that were no longer medically necessary or were not ordered by the treating physician
• Billing for or providing a more expensive product that the one the patient was actually provided
• Kickbacks from suppliers to physicians for referrals
• Submitting claims for nonexistent patients by using borrowed social security numbers

These schemes, when they result in fraudulent payments from government-funded healthcare programs like Medicare and Medicaid, can constitute violations that can be the basis of a qui tam whistleblower lawsuit under the Qui Tam provision of the False Claims Act.

Experienced Qui Tam Whistleblower Representation

If you have knowledge of any of the above schemes involving durable medical equipment fraud, you can become a whistleblower by filing a qui tam lawsuit. As a whistleblower, you can help stop fraud against the government and even receive a percentage of the amount recovered as a whistleblower reward for your service to the taxpayers.

Kenney & McCafferty is a public interest law firm whose dedicated qui tam attorneys have been assisting whistleblowers in their qui tam actions for over fifteen years. Our experience enables us to work closely with the U.S. Department of Justice and state attorney general offices to rectify cases of fraud reported by whistleblowers while simultaneously working to protect the client’s rights under the applicable provisions of the False Claims Act.

Kenney & McCafferty attorneys will consult with you about your case, without obligation. All communications with Kenney & McCafferty attorneys during these consultation services are confidential and protected by the attorney-client privilege.

If you have knowledge of a fraud or false claim against the government, please contact our qui tam lawyers today. Kenney & McCafferty attorneys will consult with you about your case, without obligation. All communications with Kenney & McCafferty attorneys during these consultation services are confidential and protected by the attorney-client privilege.