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Home Health & Hospice Week

Fraud & Abuse:

Medicaid Probe Drives Supplier Out Of Business

Published on Sun Aug 17, 2003

 DME suppliers should repeat this mantra:  documentation, documentation, documentation

A recent investigation focusing on three compliance hot spots should remind durable medical equipment suppliers they can't let up on documentation efforts for Medicaid.

Failure to keep on top of documentation can be catastrophic, as a Brighton, MA supplier recently learned. According to Massachusetts Attorney General Tom Reilly, Leonid Kopilevich, operator of Elaine Mishel Shoe Store - a DME supplier since 1985 - agreed to settle Medicaid fraud allegations by paying more than $336,000.

On top of that, Kopilevich and his mother, Elaine Mishel co-owner Rosalaya Kopilevich, were not only ousted from Medicaid in the Bay State, but also agreed never to apply to become a Medicaid provider anywhere in the U.S. The Kopileviches shut down their business July 1.

The allegation centered on three key issues, according to Reilly:

  • failing to maintain sufficient documentation - such as manufacturer invoices - to prove that they gave Medicaid the best possible price;

  • overbilling Medicaid for back supports, knee and elbow orthoses, blood pressure kits and other supplies; and

  • billing for medically unnecessary products, including heat lamps and elastic support stockings.

    Reilly claims the pair also engaged in "questionable" bulk billing - i.e., delivering a full year's supply of a product and billing Medicaid all at once. As a result of the investigation, the AG says, Massachusetts' Medicaid program now prohibits bulk billing.

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