DRG False Claims – See Diagnosis Related Group Health Fraud in the Glossary.
Drug – the Federal Food, Drug and Cosmetic Act defines drugs as articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals; and articles (other than food) intended to affect the structure or any function of the body of man or other animals;
Drug Application Fraud – See New Drug Application Fraud in this Glossary, See Abbreviated New Drug Application Fraud in this Glossary, and 505(b)(2) Application Fraud in this Glossary.
Drug company kickback – when a pharmaceutical company provides inducements to doctors or other healthcare providers to prescribe its drugs. See also Anti-Kickback Law in this Glossary, and See Continuing Medical Education Fraud in this Glossary;
DSH Fraud – See Disproportionate Share Payments (DSH) Fraud in this Glossary.
Durable Medical Equipment (DME) Fraud – equipment that can be used over and over again, such as wheelchairs and oxygen equipment. The DME must be appropriate for use in the home or other non-inpatient type living facilities. It must be medically necessary and be prescribed by a physician, and not intended for use as a convenience item. Questions to ask include, are the medical supplies and equipment medically necessary? (2) were the items not provided as claimed? (3) were there double billings?; and (4) was the provider paying or receiving kickbacks in exchange for Medicare or Medicaid referrals? Did a physician knowingly order them? Is the appropriate documentation really on file when DME suppliers file claims with ZX, KX, and KS modifiers? Does the contractual arrangement between a hospital/nursing facility the DME company, violate the Stark and/or Anti-kickback law either explicitly or by practice?