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Claims of DME Fraud Lead to Jail Time

Device Regulation Alert: Safety, Compliance and Reimbursement News, March 31, 2008

Dallas and Florida DME suppliers and a California physician are heading to jail for charges relating to DME claims.

In Florida, a DME company owner and operator was sentenced to 39 months in jail after pleading guilty to charges relating to Medicare claims for DME items and services that didn't exist, according to a Department of Justice (DOJ) press release. According to the DOJ, Medicare was billed for over $10 million and it paid approximately $1.1 million.

In Dallas, two DME suppliers were sentenced to 37 and 30 months in jail after both pled guilty to conspiracy to commit healthcare fraud, according to a DOJ press release. Each supplier was ordered to pay more than $400,000 in restitution to Medicare.

According to the release, both admitted in their guilty pleas to conspiring to pay kickbacks to a Dallas physician in exchange for certificates of medical necessity for power wheelchairs and accessories that were billed to Medicare. According to the DOJ, the conspiracy resulted in more than $1.7 million in Medicare claims of which Medicare paid more than $900,000.

Finally, according to the OIG's February report on recent criminal enforcement actions, a California physician was sentenced to 30 months in jail for DME-related fraud. The OIG claimed the physician received kickbacks from a DME supplier in exchange for prescriptions and certificates of medical necessity for wheelchairs, nutrition products, and hospital beds the OIG said were not necessary and in some cases never provided.

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