Medicare has recently intensified its focus on durable medical equipment (DME) due to concerns about fraud and overpayments. Common schemes of DME fraud include billing for equipment that was never provided, upcoding to more expensive items, or prescribing medically unnecessary equipment (e.g., wheelchairs, oxygen equipment, and orthotics, diabetes supplies etc.). To combat this, Medicare has implemented stricter oversight measures and increased audits of DME suppliers.
A prime example is the recent case involving a Montana Physician Case charged for committing almost $39 million for fraudulent billing of Medicare and other federal benefits programs during the Covid-19 pandemic. According to the criminal charging document by the U.S. Attorney’s Office, Ronald David Dean, and emergency department physician, signed prescriptions and other documents for medical devices and Covid-19 tests for patients he never saw or communicated with, who did not need them, and who did not request them. In turn, 2 individuals running different telemedicine companies, where Dean was an independent contractor, then billed the Federal government for the costs. Dean would then receive payments as part of a kickback scheme. Under a plea deal with the government, if approved by the judge, Dean will have to pay back over $700,000 in restitution to Medicare and other federal programs and plead guilty to conspiracy to commit wire fraud, which carries a maximum sentence of up to 20 years in prison, a $250,000 fine and 3 years supervised release.
We will continue to see more Medicare billing fraud cases related to DME, and this case is a reminder of the civil and criminal consequences. Medicare is paying attention.
The attorneys at Chilivis Grubman represent healthcare providers of all types and sizes in connection with Medicare, Medicaid, and commercial payor billing fraud matters. If you need assistance, please contact us today.