Becoming a Whistleblower, and exposing durable medical equipment fraud, helps ensure that medical equipment is safe and that precious healthcare resources are appropriately utilized.
Becoming a Whistleblower, and exposing durable medical equipment fraud, helps ensure that medical equipment is safe and that precious healthcare resources are appropriately utilized. Delivering unnecessary medical equipment results in excessive costs to the healthcare system, ultimately limiting the availability of necessary medical supplies & equipment for all. A healthcare system in crisis cannot afford such waste, and becoming a Whistleblower is an honorable way of doing your part.
Durable Medical Equipment (“DME”) fraud is on the rise as our population continues to age. Wheelchairs, prosthetic devices, portable oxygen tanks, orthotics, implants and related services --- DME fraud hinders society’s ability to provide appropriate healthcare to our elderly and disabled.
DME fraud often involves issues such as:
- payments to reward the referral of patients;
- various types of billing-related fraud, including:
- upcoding, which occurs when a health care provider submits a claim for an item of durable medical equipment which misuses standardized billing codes so as to obtain more money than is allowed by law;
- submission of a claim for durable medical equipment that were never delivered to a valid patient; and
- lack of medical necessity, a fraud where a health care provider submits a claim for durable medical equipment that are not medically necessary.
Durable Medical Equipment fraud resulting in whistleblower rewards include:
Gambro Healthcare Agrees to Pay $500 Million to Resolve Allegations in Medicare Fraud Case
Settled allegations that it:
- provided home dialysis patients equipment and supplies through a “shell” durable medical equipment company, solely to receive higher reimbursement;
- hired and compensated physicians as medical directors based on the number and volume of anticipated patient referrals to Gambro clinics; and
- engaged in “hard coding” of diagnostic codes on submitted claims, resulting in bills being submitted for ancillary medications and services which were not medically necessary.
The relators received more than $45 million.
Medical Device Makers Enter $310 Million Settlement
Settled allegations that it gave illegal kickbacks to surgeons as incentives to use their products.
“With these settlements in place, we expect doctors to make decisions based on what is in the best interest of their patients, not the best interest of their bank accounts.”
Dialysis Provider to Pay $486 Million to Settle Charges
Settled allegations that it:
- conspired to defraud government payers by charging for disputed intravenous feeding of dialysis patients;
- charged for blood tests deemed unnecessary; and
- violated anti-kickback laws by providing payments, discounts, yacht trips and bear-hunting excursions in Alaska to attract potential customers for the LifeChem blood-testing business.
“The government complaint said the home care unit falsely attributed patients' weight loss to kidney-related problems. In one case, it said, weight loss resulting from the amputation of a patient's leg was misattributed.”
The relators in the case received $65.8 million.
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If you have first-hand knowledge of a major durable medical equipment fraud on the U.S. government, Whistleblowers Against Fraud can help you Maximize Your Whistleblower Reward. Contact us to Blow the Whistle on fraud and receive a free strategic assessment of your whistleblower information.
