As many medical practices are aware, Durable Medical Equipment (DME) fraud is running rampant, and you could be pulled into a case even if you didn’t knowingly violate the Stark law or Anti-Kickback Statute. Why? Because a DME supplier who violates these laws could present your provider’s DME prescriptions as evidence to shift liability away from themselves and toward your practice instead.
One key way to protect your practice is to avoid forging relationships with DME suppliers that are at risk of committing violations. DME and Stark Law issues have persisted for decades, and if you don’t know what to look for, you could build relationships with shady DME providers who could end up putting the blame on your practice when they’re the ones billing improperly.
To ensure that you aren’t on the wrong side of DME and Stark Law accusations, consider these five ways you can spot risky DME providers to protect yourself.
1. The Provider Has a Financial Interest in the DME Firm
If your physician, a member of their family, or a close friend of theirs has a financial interest in the DME company that does business with practice, then the chances of your practice violating the Stark Law are extremely high. Stark prohibits you from “self-referring,” which means you’re referring patients to a place where you or a family member have a financial interest. Your DME provider should be totally separate from your practice’s providers and their families.
2. The DME Supplier Gives You Gifts
If you notice that the DME supplier provides freebies (goods or services) to your medical practice or to patients that go beyond limited sampling programs, that could be a red flag. The OIG would be likely to see these as inducements to use that supplier’s services, which is against the law.
3. The DME Supplier Only Accepts Medicare
Although it’s possible that some providers accept only Medicare, it’s not particularly common. If your DME provider accepts just Medicare or just Medicaid, it’s a sign that you should look more deeply into whether they’ve been set up for the sole purpose of committing Medicare (or Medicaid) fraud.
4. The DME Supplier Offers to Pay Your Provider for DME Orders
If the DME company offers to pay your practice a certain fee for every DME order, that’s an immediate red flag that they’re committing fraud. This is a clear violation of the Anti-Kickback Statute.
5. You’re Asked to Sign DME Orders for Patients You Haven’t Seen
If a telemedicine company contacts you and asks you to sign orders without an adequate patient examination or to sign orders for a patient who’s not in your practice, that’s obviously a red flag. DME should only be prescribed when it’s reasonable and necessary.
Contact an Attorney With Questions
If you recognize your practice in any of these red flags, it may not necessarily mean you’re violating any laws, but it could be a good reason to ask an attorney to review your DME relationships to ensure you are staying on the right side of the law.
Want to know more about unlawful Stark Law and Anti-Kickback Statute situations including Durable Medical Equipment (DME) fraud? Check out the 60-minute online training, Avoid Severe OIG Stark & Anti-Kickback Fines. Compliance expert Lynn M. Adams, Esq. will provide you with proven strategies that can help you stay on the right side of the Anti-Kickback and Stark law when prescribing DME.
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