For example, DOJ recently indicted a DME provider in South Texas who pled guilty to a felony charge of conspiracy for violating the federal Anti-Kickback Statute:
“The federal anti-kickback statute prohibits individuals and entities from knowingly and willfully paying or offering to pay, as well as soliciting or receiving remuneration (money or things of value) in return for the referral of patients for medical services or items which are benefits under a federal health care program, such as Medicare or Medicaid. A violation of the statute is a felony offense.”
The DME service provider’s owner now faces up to 5 years in federal prison and a $250,000 fine. DME providers should, at a bare minimum, make sure they have supporting documentation for all ordered equipment and supplies from the referring physician they do business with. This would include diagnostic information, supporting medical tests, and physician orders for medically necessary equipment and supplies. Such documentation is essential to supporting your DME claims in the event of a RAC audit or law enforcement investigation.