How to Report Durable Medical Equipment Fraud: What You Know From Inside the Business

To decide how to report durable medical equipment fraud, speak with our whistleblower experts about what happened inside the business. The order may say a patient needed a ventilator. The therapist may know it sat unused. The billing department may know Medicare kept paying. Your part of that story can connect what the company claimed to what happened in the patient’s home.

What Evidence Is Needed to Report Medicare Fraud?

Useful evidence connects the equipment, the order and the claim to the people who made the decisions. We start with your role, the companies involved, when the conduct happened and how you know about it. An account of what you saw, the records you worked with and the instructions you received gives us something concrete to assess.

The first conversation can begin with that account. You do not need a complete company file or an answer to every billing question. We distinguish what you remember, what documents you already hold and what records you know exist elsewhere. Patient information and document transfer are matters we work through with you and the durable medical equipment fraud whistleblower lawyers we bring into the case.

If you can explain where the order, delivery or billing went wrong, report durable medical equipment fraud to our whistleblower experts. We assess the connection between what you know and the government’s payments, then build the case strategy with you.

Where Your Work Fits in a DME Fraud Case

Durable medical equipment moves through several hands before a supplier bills for it. A marketer may generate the lead, a clinician signs the order, and the supplier arranges fulfillment and submits the claim. The supplier also keeps the supporting records. The person who can explain a false claim may work at any of those points.

Call Centers and Patient Acquisition

A call-center employee can explain the offer that brought the patient in: the script, the marketing company, what the patient requested and what staff were told about payment. A promise of free equipment can connect directly to the company’s copayment and replacement practices.

In the Arriva Medical case in the Middle District of Tennessee, the Justice Department alleged that the supplier used free glucose meters and routine copayment waivers as kickbacks to Medicare beneficiaries. The allegations also covered replacement meters for ineligible patients and claims for deceased beneficiaries. A former call-center employee brought the whistleblower case.

The government’s amended complaint quoted an employee tying financial assistance to exclusive purchasing:

The statement connects the help offered to the patient with the sales the supplier expected in return. For someone who worked those calls, the offer, account notes and instructions about collecting copayments belong to the same story.

The call’s origin matters too. Centers for Medicare & Medicaid Services guidance enclosed with an HHS Office of Inspector General letter distinguishes a physician contacting a supplier with the patient’s knowledge from a supplier calling solely because it received an order. The guidance also bars an initial call about a prescribed item from becoming a sales pitch for additional covered items. A call-center employee may know exactly how the conversation started and which additional products the script introduced.

Prescribers, Clinical Reviewers and Staffing Employees

The order’s signature is only part of the evidence. Who filled in the clinical information, what contact the clinician had with the patient and how the reviewer was paid can explain how the order came into existence.

In an Eastern District of Washington settlement involving Jackson & Coker LocumTenens, the Justice Department described allegations that telemarketers generated orders and supporting documents that made it appear a physician was treating beneficiaries. Nationwide Health Advocates sent those documents electronically to a physician retained through the staffing company. The physician allegedly signed nearly every order reviewed without treating or even speaking to the beneficiaries. Nationwide paid the staffing company, which paid the physician for each review.

A reviewer may recognize the completed fields that arrived before any patient conversation. A staffing employee may recognize the payment schedule. Together, those records can explain how an apparently clinical decision became a paid approval.

Wheelchair Sales and Clinical Documentation

Original prescriptions and the versions sent for billing can tell different stories. The important details include the encounter date, signatures, chart entries and who requested a change.

In the District of Utah case against Orbit Medical, the government alleged that sales representatives changed prescription and chart dates, altered documents to establish medical necessity, forged physician signatures and added fax stamps to make documents appear to have come from a physician’s office. Two former employees brought the case.

Someone who handled those versions may know which document came from the treating office and which one staff changed afterward. The equipment could be real while the account of why the patient qualified had been rewritten.

Oxygen Delivery, Respiratory Therapy and Billing

Delivery and patient use can expose a recurring claim that the billing system keeps generating. A route employee knows what reached the home. A therapist knows whether the patient used the device. Billing staff see what the company charged afterward.

Rotech Healthcare agreed to pay $9.68 million in a Medicare settlement arising from a former billing employee’s whistleblower case in the Eastern District of Texas. Rotech admitted knowingly billing for portable oxygen contents that beneficiaries did not use or require, regardless of whether the contents were delivered. It continued the practice despite knowing it produced claims ineligible for reimbursement. Taxpayers were paying for oxygen nobody used.

A separate whistleblower complaint against Oxygen Plus in the Eastern District of Kentucky alleged that a respiratory therapist saw ventilators sitting unused during home visits while the company continued billing Medicare and Kentucky Medicaid. The home visit and the next rental claim capture different sides of the same equipment. That is the comparison an employee’s account can make possible.

Refill and Fulfillment Staff

Refill fraud can sit between an ongoing prescription and the next shipment. The order may allow later refills, but Centers for Medicare & Medicaid Services refill guidance requires contact and confirmation that the patient needs the supplies. Suppliers cannot automatically ship on a predetermined schedule even when the patient has authorized it.

For shipped refills, the patient’s confirmation, its date and the shipment record show whether the company obtained confirmation before sending the goods. A text or email can document the response. An outgoing message alone does not show that the patient answered.

The documentation requirements changed on January 1, 2024: suppliers no longer had to document how much remained or whether reusable supplies still worked. The patient’s refill request still has to be recorded before the box ships.

Patient Service, Returns and Discontinued Use

Patient-service employees may receive the information that should stop recurring billing: equipment returned, supplies no longer used or notice that a patient died. The account note and the claims after it can show what the company knew and what it kept charging.

The Centers for Medicare & Medicaid Services documentation policy requires suppliers to stop billing Medicare for rental items or ongoing supplies that the beneficiary no longer uses. The Arriva allegations also show why the timing of a death notice matters: the government’s complaint described a shipment and bill after an eligibility check already showed that the patient had died. We examine the notice, who received it and the subsequent claims together.

Orthotics Fabrication, Fitting and Coding

The product and the work performed on it can contradict the billing code. Fabrication and fitting staff know whether a device was individually made, what patient-specific work occurred and who actually treated the patient.

In a Massachusetts settlement involving Joint Active Systems and New England Orthotics & Prosthetics, the government alleged that devices billed to state Medicaid programs as custom-fabricated orthotics were neither orthotics nor custom-fabricated. The clinic claimed to have treated the patients, while manufacturer-affiliated sales representatives allegedly measured, fitted and delivered the devices.

The same announcement alleged that Joint Active Systems billed Medicare for devices as orthotics despite contrary guidance from a Medicare contractor. Product records explain what was supplied. The contractor’s guidance and later billing explain what the company did after being told how its devices should be classified.

Manufacturers and Referral Arrangements

A referral payment can take the form of something the receiving practice would otherwise have to buy. Sales staff may know the samples, discounts or supplies offered and the prescribing commitment expected in return.

In the C.R. Bard settlement announced in the Northern District of Georgia, the government alleged that discounts and excessive free samples persuaded urology practices to use Bard’s catheter prescription form. After Bard acquired Liberator Medical, the government alleged, the form also steered prescriptions through that supplier.

The offer to the practice, the form used and the supplier receiving the order connect the benefit to the business it generated. Those relationships may be visible to a manufacturer or referral employee who never submits a claim.

Ownership, Enrollment and Accreditation Staff

The company on the enrollment paperwork may conceal who controls the business. Ownership records, purchase agreements and the actual operation behind a supplier location give us a way to examine that gap. Accreditation staff may also know how the location described in the paperwork compared with the business they saw.

The Operation Gold Rush criminal indictment alleged that an organization bought durable medical equipment companies already able to bill Medicare, used paid nominee owners and created corporate records falsely identifying those nominees as the people in control. An employee who handled an acquisition or enrollment may understand a part of the claim operation that never appears on an equipment order.

Audit Response and Compliance Staff

An audit response has its own history: what was requested, which records already existed, what changed and who approved the response. Compliance employees may know when a warning reached management and which billing instructions continued afterward.

In a criminal guilty plea involving a West Des Moines medical supply operator, the operator admitted providing a false document during a civil False Claims Act investigation. The document submitted to explain the billing became part of the misconduct. We assess the versions and the instructions behind them with the people who know how the file changed.

Why Does the Payer Matter?

The payer identifies whose money the claim sought and which payment rules applied. Medicare, a state Medicaid program and another federal health care program can appear in the same durable medical equipment business.

The Orbit case involved Medicare, the Federal Employees Health Benefits Plan and the Defense Health Agency. The Joint Active Systems allegations included Medicaid billing in Connecticut, Massachusetts and Rhode Island. A report that identifies the actual payer gives us a more precise starting point than a general description of healthcare fraud.

Medicare Advantage claims also belong in this conversation. In a Lincare Holdings settlement, the company admitted improperly billing Medicare Advantage plans, traditional Medicare and beneficiaries for oxygen rentals after it had already received three years of payments. Former employees brought the whistleblower case, and the government joined it.

What Happens When You Report Medicare Fraud?

When you contact us, we assess the conduct and evidence with you, develop the case strategy and bring in whistleblower lawyers who understand durable medical equipment billing. Your account helps us connect the clinical, fulfillment and financial parts of the business.

A qui tam case allows a private person to pursue false claims on the government’s behalf and share in a recovery. Our work with you focuses on the whistleblower case your knowledge could support.

Questions about anonymity, a report already made or your own part in the conduct belong in that conversation with us and your durable medical equipment fraud whistleblower counsel. We work through those questions with you.

What Is the Reward for a Medicare Fraud Whistleblower?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

Arriva Medical’s case shows what an employee’s knowledge can lead to. The Justice Department announced a $160 million settlement and a whistleblower share of about $28.5 million for the former call-center employee. The case connected the sales offer to copayment practices, replacement eligibility and claims. We assess your case around the conduct and payments your evidence can establish.

Your Knowledge Can Reach Beyond Your Department

If you know who changed an order, kept a refill running or billed after delivery stopped, speak with our whistleblower experts about the decisions behind those claims. We connect your knowledge to the money, build your strongest durable medical equipment fraud whistleblower case and bring in whistleblower lawyers who know the equipment and the billing. We stay beside you through the pursuit of the government’s recovery and your share.