A NYC Criminal Lawyer Explains Durable Medical Equipment Fraud
Durable medical equipment includes things like mobility scooters, prosthetics, back braces, hospital beds, and other reusable equipment that is used to provide treatment to the ill or injured. Insurance, including Medicare and Medicaid, may cover the costs associated with durable medical equipment. However, specific qualifying criteria must be fulfilled in order for insurance providers to pay for equipment that patients needs or that doctors recommend.
Submitting claims for equipment that should not be covered, or making false or misleading statements to obtain payments for durable medical equipment, can be considered a form of illegal fraud. The federal government may press criminal charges, or defendants involved in making false statements may face state-level charges. Civil lawsuits to recover improperly obtained funds are also very common.
If you or your organization has been accused of durable medical equipment fraud, your financial security may be at stake and you may face a threat to your freedom or to the continued existence of your business operations. You need to be aggressive and strategic in responding to allegations, and Bukh Law Firm, PLLC is here to help. Our New York criminal defense lawyers understand how to represent clients in durable medical equipment fraud cases and we can represent those facing criminal and civil liability.
What is Durable Medical Equipment Fraud?
Durable medical equipment should be covered by Medicare and certain other insurers if it is provided by a supplier who is enrolled in a Durable Medical Equipment (DME) program and if the patient receiving the equipment meets criteria specified for that particular medical item.
Fraud may occur whenever there is an attempt to mislead, including material misstatements and material omissions, in connection with the provision of durable medical equipment or in connection with billing for equipment.
Examples of DME fraud include:
- Suppliers offering free equipment to patients, which they are actually billing Medicare for.
- DME suppliers who refer patients to doctors who prescribe unnecessary medical equipment.
- Doctors or other care providers who prescribe and provide medical equipment a patient does not need and/or did not ask for.
- Providers billing for DME that a patient did not receive.
- Companies billing for duplicate orders for durable medical equipment.
- Suppliers or providers who bill Medicare for durable medical equipment for patients who have passed away.
- Suppliers who bill for costly name-brand products but who provide generic and less expensive products to patients.
- Older adults who are covered by Medicare and who allow doctors or DME suppliers to use their Medicare number and bill for durable medical equipment in exchange for the senior receiving money or other benefits.
Kickbacks are also illegal under the law, so a DME supplier who pays doctors to prescribe medical equipment which is subsequently billed to Medicare could also be guilty of durable medical equipment fraud.
Penalties for Durable Medical Equipment Fraud
Penalties for durable medical equipment fraud can include criminal charges for a wide variety of healthcare fraud offenses, health insurance fraud, or kickback fraud. Doctors, patients who knowingly allow their Medicare number to be used for fraudulent activity, and other individuals could be imprisoned if convicted under federal or state anti-fraud laws. Companies, including DME suppliers, could also face criminal prosecution which results in significant penalties including large fines.
In addition to criminal prosecution at the federal level or state level, those who have been accused of durable medical equipment fraud may also find themselves facing a civil lawsuit. Qui tam lawsuits may be filed by whistleblowers, who get to keep part of the money they help the government to recover in fraud cases. The government itself may also pursue a civil claim to recover money improperly paid out as a result of fraudulent claims.
How Can a NY Criminal Defense Lawyer Help in Healthcare Fraud Cases
Bukh Law Firm, PLLC provides legal representation to clients who have been accused of involvement with a variety of different healthcare fraud scams, including durable medical equipment fraud. Our experienced legal team understands the complex rules related to the federal Medicare system and we understand the laws related to insurance claims with private insurers. We provide aggressive and strategic advocacy so you can fight back against both criminal and civil claims against you. Give us a call today to learn more.
