Equipment and Supplies Coverage Issues

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Durable medical equipment (DME), prosthetics, orthotics, and medical supplies must be prescribed and are for use in the patient’s home. Some types might be carried with you away from home. A hospital or nursing facility providing skilled nursing or rehabilitative services is not considered a home.

The types of practices below are abusive or fraudulent:

Marketing Violations

  • Making unsolicited calls to beneficiaries to market items such as diabetes supplies or back braces
  • Requesting beneficiaries’ health information, such as Medicare numbers and physician names, during unsolicited calls

Billing Practices

  • Billing for rental equipment after date of return
  • Billing for equipment before it is delivered
  • Billing for equipment or supplies never provided
  • Billing that inappropriately overlaps with patients' hospital or skilled nursing facility stays
  • Refusing to pick up equipment after contact by recipient or physician and continuing to bill
  • Providing off-the-shelf items, such as shoe inserts, but billing Medicare for more expensive or custom-made items, such as custom diabetic shoes
  • Billing for unnecessary or excessive repair or maintenance costs

Falsely Documenting Medical Necessity

  • Completing documentation to show medical necessity for a patient not professionally known by the physician or treating practitioner
  • A supplier completing sections of necessary documentation reserved for the physician or treating practitioner
  • Falsifying documents to justify providing (or billing for) supplies to beneficiaries who do not otherwise meet the medical necessity requirement
  • Sending faxes to physicians requesting they sign off on equipment and supplies for individual patients is one way unethical suppliers attempt to obtain documentation regardless of true medical necessity. These faxes are sometimes the consequence of information gained through marketing violations.

Dumping of Supplies

  • Excessive amount of supplies delivered to a recipient that cannot possibly be used within the prescribed time frame
  • Supplies delivered for equipment the recipient no longer uses
  • Supplies delivered when there is no prescribed equipment to justify the delivery of supplies
  • Delivery of supplies or equipment that the beneficiary does not need or did not ask for
  • “Free” offers
  • Offering free supplies in exchange for Medicare numbers (and then billing Medicare, of course)
  • Offering free meals, food, or nutritional supplements, then billing Medicare for costly liquid nutritional supplies only given through tube feedings

Report Suspected Fraud

To report suspected fraud, click here.