Medicare spends roughly $10 billion every year for Durable Medical Equipment (DME).  Because reimbursement for equipment can be significantly higher than the cost of its purchase by a medical practice or manufacture by a company, fraud has been a significant problem.

What is DME Fraud?

Physicians, suppliers and home health agencies have billed for items that were not warranted and the government has needlessly paid out money at the taxpayers expense.  If you have information about Medicare reimbursement of fraudulent health care costs, you may be entitled to a reward if the government successfully recovers money under the False Claims Act as a result of your information.

What is Covered Under DME?

Medicare covers patient costs for DME that is appropriate for a patient’s home, fit for repeated use, primarily serves a medical purpose and is not generally useful absent illness or injury. For qualifying patients, a few examples of covered items include mobility assistive equipment (wheelchairs, canes, etc), medical beds and oxygen systems.

How Does DME Qualify For Medicare?

In order to cover the purchase of some of this equipment, a physician (or other eligible care provider) must certify its necessity and have conducted a face-to-face encounter with the patient in the preceding six months.

Lack of Medical Necessity
Lack of Documentation
Billing for Patients

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