Defend yourself against DME fraud charges

Given that the feds are set to tighten their scrutiny on physicians’ relationships with durable medical equipment (DME) suppliers, how can you be sure that the companies you’re dealing with are reputable? The disturbing answer is, you really can’t.

With home health care, you’re on surer ground, experts say. After all, physicians must develop a plan of care to certify medical necessity, and that plan must be reviewed periodically and adjusted as the situation warrants, says Ben St. John, a spokesman for the Office of the Inspector General. "So a physician would probably have greater awareness as to the circumstances of what’s being delivered in the way of care," he says.

With DME suppliers, however, the physician merely sends the prescription to the DME supplier, who must keep that paperwork on file. Physicians are not automatically notified about subsequent bills submitted to Medicare. DME suppliers that have run into trouble with the law before are listed on the OIG’s web site (http://www.dhhs.gov/ progorg/oig/), but the list may not help to identify fly-by-night companies or companies that are currently under investigation by either the OIG or a DME regional carrier.

That’s not to say that help isn’t available, however. "We have a lot of information to share with our physician community," says Sandra Anthony, with the anti-fraud unit at Palmetto Government Benefits Administration in Columbia, SC. "There are advisories available, and they have access to us." Ultimately, however, the best defense against fraud charges is to be scrupulous in your own documentation and wary of aggressive suppliers who, for example, approach you with amendments to DME prescriptions or offer to reduce your burden by filling out part of the paperwork for you.