RS Medical: Missing Orders Across Six Medical Equipment Lines

In the RS Medical 2013 Medicare equipment settlement, the company agreed to pay $1,214,665 to resolve allegations that employees submitted claims lacking physician orders, required supporting documentation and/or medical necessity. The claims covered electrical stimulation equipment and braces, putting Medicare and the taxpayers behind it on the bill for products the government said lacked the support for payment.

International Rehabilitative Sciences, doing business as RS Medical, reached the settlement announced on May 16, 2013. The Department of Health and Human Services Inspector General’s account of the South Carolina False Claims Act case identifies employees in South Carolina and Illinois as submitting the Medicare claims.

Six Product Lines Behind the Medicare Claims

The RS Medical settlement covered allegations involving TENS units, conductive garments for TENS units, back braces, cervical traction systems, muscle stimulators, and custom-fit knee braces.

Missing Orders and Medical Necessity Are Different Questions

The government alleged that the RS Medical claims lacked physician orders, required supporting documentation and/or medical necessity.

Someone handling incoming prescriptions may know how an order reached the company and which item it covered. That knowledge gives us a place to connect the clinical decision with the claim submitted for payment.

In examining a healthcare supplier’s billing, we look at both: what the order says and what supports it. A file can contain a prescription while leaving the medical basis for the billed equipment in question.

The RS Medical allegations went beyond missing paperwork to whether the equipment was medically necessary. Medicare was being asked to pay for equipment whose medical justification the government challenged. Reducing that allegation to an administrative filing problem misses what the payment was supposed to buy.

For an employee, the useful connection is between the specific item, the clinical support and the submitted claim. We work through that connection with people who know the orders or billing from inside the business.

Orbit Medical Shows What Altered Claim Support Looked Like

In a separate case, the government alleged that Orbit Medical‘s sales representatives altered prescriptions and supporting records to get power-wheelchair and accessory claims paid.

TENS Supplies and the Assumption That a Patient Needed More

The government alleged that Empi sales representatives induced TRICARE beneficiaries to order excessive TENS electrodes by acting as though the beneficiaries had indicated a need for them.

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.

Durable medical equipment employees who know how prescriptions and supporting records move through a supplier can bring an inside account of the claims. Our work is to develop that account into a case with whistleblower lawyers who understand health care billing and the equipment involved.

You Know What Reached Billing

If you saw Medicare equipment claims go forward without the orders or medical support behind them, talk with our whistleblower experts. We build your strongest case around your knowledge of the supplier’s decisions, bring in Medicare durable medical equipment fraud whistleblower lawyers, and stay beside you through the case.