Home Health & Hospice Week

If you're not on your best behavior, it could mean criminal charges. It's not just your imagination -- the feds are coming down especially hard on durable medical equipment suppliers these days. Just take a look at the HHS Office of Inspector General's latest semiannual report to Congress. In the OIG's examples of enforcement actions from October 2003 to March 2004, other providers such as hospitals and nursing homes are described as having mostly civil settlements involving corporate integrity agreements or restitution. In contrast, "with one exception, all of the listed items [for suppliers] involved a criminal plea or a conviction," notes attorney John Wester with Sidley Austin Brown & Wood in Washington, DC. "The range of suppliers and conduct covered by the criminal cases indicates the OIG and the Department of Justice are devoting significant attention to the DME sector," Wester warns. Bad Reputation Plagues Suppliers Suppliers such as those highlighted in the OIG report are making life harder for everyone, laments attorney Seth Lundy with Fulbright & Jaworski in Washington, DC. "There are a small number of bad actors whose activities are so egregious that they raise the level of scrutiny for all other suppliers," Lundy tells Eli. Being painted with a broad fraud brush, thanks to the few rotten apples, is a "significant issue facing all DME suppliers," Lundy cautions. The OIG has made no secret of the fact that it has it in for the industry. The watchdog agency "has devoted considerable resources to conducting investigations, evaluations and audits in the area of medical equipment and supplies," the Acting IG Dara Corrigan testified in an April 28 hearing held by the Senate Finance Committee. "This area of the Medicare program has been particularly susceptible to fraud, waste and abuse over the years" (see Eli's HCW, Vol. XIII, No. 17). And of course lately, power wheelchairs have been investigators'favorite target area. The OIG lists in its report two high-profile Florida cases resulting in millions in restitution and jail time for eight individuals. In one of the cases, the supplier submitted Medicare claims for power wheelchairs "that were either not provided, were used or refurbished but billed as new, or were exchanged for less expensive scooters," the OIG recounts. The supplier also billed for unnecessary repairs of the equipment and paid kickbacks for wheelchair referrals. These will be far from the last wheelchair cases splashed across newspaper headlines, predicts attorney Clay Stribling with Brown & Fortunato in Amarillo, TX. "In addition to the Florida cases cited in the report, high profile cases in Houston and Dallas indicate that power mobility fraud enforcement will continue to be a priority," Stribling says. "There are a small number of bad actors [...]