Las Vegas Durable Medical Equipment (DME) Fraud Lawyer

Durable Medical Equipment Fraud Defense Lawyer in Las Vegas, NV

Durable medical equipment includes essential items like mobility scooters, prosthetics, back braces, hospital beds, and other reusable equipment used to treat the ill or injured. Insurance coverage, including Medicare and Medicaid, may cover the costs associated with durable medical equipment, provided certain qualifying criteria are met. The equipment must be prescribed by a doctor or necessary for patient care.

It’s important to understand that engaging in fraudulent activities, such as submitting claims for non-covered equipment or providing false information to obtain payments for durable medical equipment, is illegal. Offenders may face criminal charges at the federal level, while false statements can also lead to state-level charges. Additionally, civil lawsuits are often pursued to recover improperly obtained funds.

If you or your organization is accused of durable medical equipment fraud, a proactive and strategic approach is crucial. Spartacus Law Firm is here to help. Our experienced federal criminal defense attorney has the knowledge and expertise to represent clients in both criminal and civil durable medical equipment fraud cases.

Understanding Durable Medical Equipment Fraud

Medicare and select other insurers typically cover durable medical equipment (DME) if it is supplied by an enrolled provider and the patient meets the specified criteria for that item. Fraud can occur when there is an attempt to deceive, including making significant misstatements or omissions, related to the provision or billing of DME. Examples of DME fraud include:

• Suppliers offer patients free equipment but secretly bill Medicare for it.
• DME suppliers refer patients to doctors who prescribe unnecessary medical equipment.
• Doctors or care providers prescribe and supply unnecessary medical equipment, regardless of patient need or request.
• Providers bill for DME that patients never receive.
• Companies bill for duplicate orders of durable medical equipment.
• Suppliers or providers bill Medicare for DME for deceased patients.
• Suppliers bill for expensive name-brand products but provide generic, cheaper alternatives to patients.
• Older adults covered by Medicare allow doctors or DME suppliers to use their Medicare number to bill for DME in exchange for financial compensation or other benefits.

Kickbacks are illegal under the law. If a DME supplier compensates doctors for prescribing equipment that is billed to Medicare, they may face criminal charges for durable medical equipment fraud.

Frequent Legal Challenges for DME Providers

1. Medical Marketing

Many DME companies engage in marketing practices that breach federal law. While business development is vital for any company’s survival, the healthcare industry’s regulations are particularly intricate. For example, classifying a marketer as either a W2 employee or a 1099 contractor can dictate whether a DME company is violating the federal Anti-Kickback Statute, which prohibits certain compensation models for referring federally-funded patients. Generally, commissions, percentage-based compensation, and individual rewards are not allowed.

Additionally, many DME companies operate without formal contracts with their marketers, a practice that lacks transparency in the eyes of federal authorities. To avoid regulatory scrutiny, it is crucial to establish marketing compensation arrangements that comply with Medicare guidelines.

2. Buying Medicare Leads

Beyond traditional marketing efforts, some DME providers and businesses purchase leads from online companies. These lead-generation firms maintain extensive databases of patients who may qualify for DME based on past surgeries, pain management visits, and other criteria. Buyers receive patient information to contact and verify the lead. In the flourishing DME market, a single lead can cost up to $500 in certain regions.

However, buying leads entails risks. The DOJ has a history of prosecuting lead agencies, DME companies, and others for misusing individuals’ personal information for medical services. These prosecutions typically focus on two main issues:

• HIPAA Violations – While not the foremost issue, HIPAA compliance remains a concern. HIPAA protects patient data from unauthorized access or disclosure. Trading such information requires explicit patient consent and a formal agreement. Unfortunately, online lead companies often lack this necessary documentation.
• Anti-Kickback Statute Violations – A significant concern with buying or selling leads is that both the CMS and the DOJ consider these transactions to violate the federal Anti-Kickback Statute. If your DME business is purchasing Medicare leads or planning to do so, it’s imperative to consult with Spartacus Law Firm immediately. He can guide you in ensuring that your arrangement adheres to the Anti-Kickback Statute and is documented in a legally sound contract.

3. Medical Necessity

Success in healthcare fundamentally relies on improving patient outcomes. While marketing plays a vital role in operating a DME (Durable Medical Equipment) business, it’s imperative to steer clear of patient brokering and avoid persuading patients to purchase unnecessary devices. The assessment of medical necessity is often neglected in the industry, with many DME companies leaving this crucial decision to doctors.

However, the Department of Justice (DOJ) scrutinizes the entire process, much like their approach to compound pharmacies. To safeguard your DME business from potential allegations, it is crucial to seek the expertise of our seasoned DME fraud defense attorney in Las Vegas. Spartacus Law Firm has honed effective defense strategies against federal healthcare fraud investigations. Don’t jeopardize your business, reputation, or freedom—contact our office to ensure you are not at risk of federal prosecution.

4. Telemedicine

Telemedicine presents unique compliance challenges for DME businesses. Although its benefits are clear, current laws haven’t fully adapted to its extensive use, particularly concerning Medicare patients. Regulations still equate telemedicine with traditional office visits, despite their significant differences. This discrepancy has created legal complexities and instances of fraud. Therefore, it is imperative for DME companies employing telemedicine to proceed with caution and seek legal counsel to minimize liability risks. For expert guidance on navigating telemedicine arrangements and protecting your DME business, contact Spartacus Law Firm.

5. No Compliance Program

Compliance errors in running a DME business are not just possible but highly likely and common. Each business owner faces a crucial decision: Do I risk mistakes, or do I ensure peace of mind with the necessary documentation and agreements to protect against criminal allegations in a federal investigation?

Assuming the government will overlook your good intentions or lack of awareness in overbilling Medicare is naive. No brain scan can attest to your character. In healthcare, the second most regulated industry in the US, the burden of proof rests squarely on you. While the government bears the burden of proof in court, this only comes into play after arrest and indictment.