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MEDICAL INSURANCE FRAUD

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DURABLE MEDICAL EQUIPMENT

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Durable Medical Equipment Fraud

Durable medical equipment covers everything from crutches to wheel chairs. There are literally hundreds of thousands of companies across the country and on the Internet selling any type of product you need to purchase.

Most are honest, but beware (of course - everything can involve some type of fraud) of those who are not.

DME companies have been caught billing insurance carriers (and Medicare/Medicaid) for  

  • Products not delivered

  • Billed for higher costing products that those delivered.

  • Billed for new equipment, when the actual equipment was used.

  • Billed for a DME product when the customer actually walked away with a new coffee pot and toaster.

There can also be kickback schemes involving health care providers and DME companies (or the sales reps), where the provider is paid to prescribe a DME device, even though one is not needed.

Another crucial bit of information is the "Rental/Purchase Agreement."  45 states require disclosures of various information.  One requirement of the disclosure (true in all 45 states) is that information be disclosed on the agreement as to whether the equipment is new or used.  If you and/or your insurance company end up purchasing the equipment for the "new" price, you have just been scammed.  Click here for statutes.

There are also plenty of products out there touting "FDA APPROVED." Be advised...FDA approval does not mean the product really works, only that it shouldn't harm you. Even today, there are snake oil salesmen out there.

Also, be aware that several states require DME companies (either for all or certain products) to be registered in their state before they can sell their products. This includes but is not limited to: Florida, Illinois, Ohio, North Carolina. Medicare and Medicaid require registration. If your state requires registration and the DME company is not registered, contact your State Attorney General or Department of Health.

When purchasing durable medical device, always confirm the charges submitted to your insurance carrier were correct.

Be wary of ads that tout they can get your insurance company to pay for the equipment or you will get it free.

'Cause who pays the fraudsters?

YOU DO!

If you think a DME company is cheating, report them!