Knowledge base

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?

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