Investigation centers on 3 compliance areas.
Durable medical equipment suppliers can't afford to overlook their documentation responsibilities when it comes to Medicaid claims.
Failure to do so 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 closed their business July 1.
The allegation centered on three key issues, according to Reilly:
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.
Lesson learned: DME suppliers should make sure they preserve ample documentation supporting both the medical necessity and the pricing of the supplies they furnish.
