Make Sure Your DME Deal Doesn’t Look Like a Kickback

Based on a recent deal in which a supplier of DME products would provide equipment to a physician in exchange for a prime space and fees, would directly violate the federal anti-kickback statute, according to the HHS Office of Inspector General latest advisory.

The basis of this decision was based on the situation where the agreement would have allowed the physician to become a DME supplier for non-Medicare patients, and the DME supplier would have rented space in the physician’s office to supply DME directly to the physician’s Medicare patients.

The reason that this arrangement raised eyebrows is because the in-house DME supply programs either together or individually, pose a “significant risk of fraud and abuse,” according to the OIG. The OIG gives any joint ventures between private pay business and physicians close examination as these situations sometimes result in fraudulent DME claims. The underlying reason is the physicians will have extra financial incentives to steer patients towards using non-Medicare DME offerings which boosts the private pay aspect of the DME business.

How can you avoid looking suspicious?
The best way to insure your DME supplier is above suspicion is to make sure they are off-site from your medical practice and that there are no other financial arrangements other than vendor-supplier roles at work.

Keep airtight documentation complete with medical necessity and other failed courses of action, if any, that led up to the DME claim. This will go a long way to insulate your practice from being scrutinized for DME improprieties.

View all Articles by: Melissa Clark, CCS-P