Last month, we dove into the government’s crackdown on telemedicine fraud across the country. Officials are seeing an alarming trend of marketing companies and call centers trying to take advantage of the shift toward telemedicine to farm patient information and use Medicare providers to unknowingly engage in illegal kickbacks and other fraudulent activities.
One of the main areas of concern for this type of fraud has been durable medical equipment (DME). This equipment includes medical necessities like wheelchairs, orthopedic braces, specialty beds, walkers, crutches, canes and the like. The telemedicine schemes surrounding them target Medicare providers such as DME companies and pharmacies. Orthotics (braces of all kinds) have been a particular area of focus for the investigators and prosecutors targeting these schemes. If you are a Medicare provider, what follows is a brief overview of how the fraud works to educate you so you don’t fall victim to it and find yourself under investigation.
Telemedicine fraudsters publish television, radio or online ads typically offering DME at no charge to the patient, and prompt the viewer to click on the banner ad or call a number on the screen. This action by the patient or consumer is sent to a call center which gathers insurance and other personal information. The patient is later contacted by phone and interviewed to determine if they qualify for the DME. If so, that information is forwarded to a telemedicine doctor who conducts an online exam which may not comply with the legal requirements to prescribe DME, but a prescription is nonetheless created.
Once this process is complete a copy of the prescription and the patient records demonstrating the medical necessity for the DME is sent back to the call center, which routes it to the manufacturer or distributor of the equipment who ships it to the patient and to the Medicare provider who bills Medicare for the product.
While this process can be beneficial for those who truly require the DME and aren’t able to leave their home, there are many who just don’t need it. The fraud comes in when there is no medical necessity for the equipment and the call centers and marketers are merely being paid for obtaining the prescription itself.
Many well meaning medical providers participate in this process without knowing that they are being taken advantage of or that they are part of a link in the commission of a crime. They are contacted by marketers offering participation in a program which will increase their orders for DME and increase their gross revenue. If you receive such a communication, contact a health care lawyer immediately to assist you before making a decision to participate! Criminal prosecutions of health care providers such as durable medical equipment companies and pharmacists find themselves caught up in this net of deception and are subjected to prosecutions which can ruin their careers and result in prison sentences and the loss of their professional licenses.
Contact Barry M. Wax, Attorney at Law and get the legal advice you need before you find yourself on the wrong side of a criminal prosecution.
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