It was recently reported by the U.S. Department of Justice that two durable medical equipment (DME) providers will pay $7.5 million to resolve allegations that false claims were submitted to federal health care programs for power wheelchairs and accessories.
"Power wheelchair suppliers must bill federal healthcare programs accurately and honestly to ensure that federal dollars are used for individuals who truly need these mobility devices," said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department's Civil Division. "The Justice Department is committed to pursuing those who seek to abuse taxpayer-funded programs."
Reimbursement Qualifications:
In order to qualify for reimbursement, a physician must conduct a face-to-face examination of the beneficiary and "provide the supplier with a written prescription for a power wheelchair within 45 days of such an encounter, along with documentation that supports the medical necessity of the advice," according to the U.S. Department of Justice report. The report goes on to say that the prescription "must be completed by the physician who performed the exam and must include the beneficiary's name, the exam date, the diagnoses and conditions the wheelchair is expected to accommodate, the length of need and the physician's signature."
These false claim allegations resolved by the settlement with the two DME providers were filed under the False Claims Act by two former employees of one of the DME providers. Under the Act, a private party can sue for false claims on behalf of the government and share in any recovery, as part of the "whistleblowers' suit."
Combating Health Care Fraud:
This settlement serves as an important reminder that the government is cracking down on combating health care fraud. "The resolution of this case helps to restore funds taken from the Medicare trust fund through the use of falsified records and billings," said U.S. Attorney Carlie Christensen of the District of Utah. "Taxpayers' dollars paid for power wheelchairs not legitimately prescribed by a physician. Health care fraud is aggressively prosecuted in Utah and every effort is made to restore government funds taken through such conduct."
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