Medicare Compliance & Reimbursement

This fraudster's plight shines big and bright ... deep in the heart of Texas.

Durable medical equipment dealers know there are harsh penalties for fraud, but here's a worst-case scenario that should scare any DME dealer straight if he is engaged in fraudulent claim filing.

DME company owner Rhonda Fleming faces two years in jail and a $1.8 million civil suit, U.S. Attorney Michael Shelby said March 7. In 2004, Medicare reportedly paid Fleming $3.7 million in fraudulent claims through her Houston, TX-based businesses, Hi-Tech Medical Supply and Delivery and Advanced Medical Billing Specialists, Inc. (AMBS). At the time, Fleming was under supervised release following 21 months' imprisonment for a previous fraud conviction.

Medicare revoked Hi-Tech's certification in 2003 after it failed to meet numerous standards. However, throughout 2004 investigators say ABMS continued billing duplicate claims as "backdated" services and equipment. Medicare's requests for supporting documentation allegedly went unanswered.

Meanwhile, more than 69 beneficiaries complained about non-delivered equipment. Investigators allegedly found many of the referring physicians listed on the claims were under indictment in south Texas. In the same year, Fleming pocketed $3.2 million in Medicare reimbursement from Hi-Tech's account, Shelby said.

The court revoked her supervised release and sentenced her to an additional two years in prison.

Lesson Learned: DME suppliers with a patchy compliance track record will very likely receive the full brunt of investigators' attentions.