Medicare Compliance & Reimbursement
Feds Going Undercover To Catch DME Fraudsters
Companies that take pains to abide by Medicare regulations may have already averted a disaster - and not even known it.
Here's why: The Federal Bureau of Investigations and the HHS Office of Inspector General are busy fronting as legitimate trading partners to gauge suppliers' compliance.
TBC Products, Inc., which distributes enteral therapy products to skilled nursing facilities, was one of several entities to get snagged by "Southern Medical Distributors" - a durable medical equipment supplier manned by undercover federal agents. TBC allegedly provided enteral nutrition infusion pumps to SMD for free in return for the supplier's agreement to buy related products. Prosecutors say TBC supplied SMD with fabricated pump rental fee invoices and credit memos, advising the undercover DME to present the invoices in the event of a Medicare audit.
After pleading guilty to obstructing a federal audit, TBC now must pay $4 million in criminal fines. But that's the least of its troubles: Under the terms of a separate civil settlement, TBC will be permanently excluded from Medicare and Medicaid.
The civil settlement, which resolves related false claim allegations, will also bleed parent company McKesson Corporation out of $3.4 million.
"These sales tactics are frequently used as a cover to obstruct Medicare's ability to discover bribes and kickbacks," said U.S. Attorney Ronald Tenpas. "Such arrangements ... prevent Medicare from monitoring the actual costs of durable medical equipment."
Lesson Learned: The feds continue to expand their arsenal against wayward entities.
Medicare Compliance & Reimbursement
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Feds Going Undercover To Catch DME Fraudsters
Companies that take pains to abide by Medicare regulations may have already averted a disaster [...]
