When Durable Medical Equipment Suppliers Fail to Follow the Medical Conditions of Their Patients

From patient enrollment to equipment delivery, every single stage of the DME supply process has fallen under the False Claims Act microscope. Increasingly, the government has zeroed in on what we call “set it and forget it” Medicare billing schemes. Here, the DME supplier appropriately approves a Medicare beneficiary to receive a particular DME. However, once the Medicare dollars start flowing, the supplier regularly delivers equipment and supplies whether or not the patient’s need for it continues.

The most recent example of the “set it and forget it” billing scheme was revealed in a $41.8 million False Claims Act settlement involving Hill-Rom Company, Inc., one of the nation’s largest DME suppliers. In this intervened qui tam action, the government alleged that the company had a practice of automatically billing for patients over long periods of time without making any reasonable effort to determine if the patients for whom it submitted the claims continued to meet Medicare conditions for payment. This “set it and forget it” approach to Medicare billing caused the company to submit false claims for patients for whom the equipment was not medically necessary, including claims for patients who had died or were no longer using the equipment.

With DME suppliers regularly relying on automated billing systems, other companies are likely engaged in this same “set it and forget it” billing practice. The whistleblowers in the qui tam action against Hill-Rom Company received $8 million, or nearly 20% of the total recovery.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.