Durable Medical Equipment (DME) Medicare Fraud has long been a target of federal healthcare fraud prosecutors and news broke yesterday that they have filed charges against what may be one of the largest schemes ever charged.
The Department of Justice announced it has charged dozens of individuals in federal courts in California, Florida, New Jersey, South Carolina, and Texas. These charges allege kickbacks, bribes, and improper referrals relating to DME orders for various types of medical braces, many of which that the government contends were medically unnecessary.
According to reports and case documents, some parts of the purported scheme involved overseas call centers and the use of telemedicine. Otherwise, the allegations resemble those in many other healthcare fraud cases – illegal kickbacks to healthcare providers for prescriptions for patients they supposedly insufficiently examined or didn’t examine at all.
Durable Medical Equipment Fraud, however allegedly committed, is a serious crime. Well-meaning and successful professionals often find themselves on the wrong end of the law when they import business practices from other fields into the medical realm. Healthcare is a highly regulated industry that operates according to a different legal framework than most other areas6 of the economy. This is particularly true where federal dollars are involved.
It has been said that if one looks at where the money goes, the U.S. Government is an “insurance company with an army.”
As long as that remains the case, and given that healthcare is a growing share of the economy populated by an increasingly aging population, one may expect law enforcement to expand, rather than shrink, its focus on “fraud, waste, and abuse.”
Whether these charges can be proven or are, in fact, related to each other, remains to be seen.