US Professional Medical Supply: Telemarketing Orders, Medicare Claims

In the US Professional Medical Supply settlement, its owner agreed to pay $224,620 to resolve allegations that he participated in a kickback scheme to bill Medicare for medically unnecessary durable medical equipment. According to the government, federal investigators learned that beneficiaries had given brief statements to telemarketers, never saw or were examined by a provider, and received equipment they did not need.

US Professional Medical Supply’s Medicare Claims

US Professional Medical Supply LLC was a Spokane Valley, Washington medical supply company set up in 2018. The Justice Department announced the owner’s settlement on August 7, 2024.

In September 2019, the owner submitted approximately 400 durable medical equipment claims to Medicare through the company. All listed him as the provider. The government alleged that the doctors who ordered the equipment solicited and received kickbacks in exchange for those orders.

Medicare paid $112,310 for the claims at issue.

How the Telemarketing Orders Became Medicare Claims

The government alleged that physician orders generated through kickbacks supported claims for equipment the beneficiaries did not need.

The release explains why the missing treatment mattered. Medicare coverage of durable medical equipment requires an order from a physician treating the beneficiary for a specific medical problem, with the equipment used in that treatment. According to the government, investigators found patients whose contact had been with the caller selling the equipment. The order presented a medical reason for the claim while the beneficiary’s account described a marketing contact.

The FBI and the Seattle Field Office of the Department of Health and Human Services Office of Inspector General investigated the case.

Why a Signed DME Order Has Commercial Value

A signed order connects the clinician’s authorization to the supplier’s opportunity to bill. CMS’s 2024 ordering data counted 381,228 clinicians ordering durable medical equipment, prosthetics, orthotics and supplies for Medicare fee-for-service beneficiaries. For a supplier, reaching healthcare providers who can order its equipment is a commercial problem.

The work can pass through separately owned businesses. Advertising or outbound calls bring in potential customers. A call center captures their information. A practitioner generates an order. A supplier receives it, furnishes the equipment and bills Medicare. Someone working at the end of that chain may see a completed prescription without seeing how the patient reached the prescribing practitioner.

In its July 2022 Special Fraud Alert on purported telemedicine companies, HHS-OIG described suspect arrangements involving call centers, staffing companies, practitioners, marketers and brokers. It identified payments described as reviews, audits, consultations or chart assessments, and arrangements in which the telemedicine company sells the resulting order to another business.

The alert also identified practitioners with too little patient contact or information to assess medical necessity, and compensation tied to the volume of items ordered. Those features explain why the commercial arrangements behind a signature matter.

It also described businesses offering only a single product or class of products, potentially restricting a practitioner’s treatment options before the patient was assessed. Some did not expect practitioners to follow up with patients. The commercial operation could decide what was available to prescribe and end its involvement once the order was produced.

AZ Diabetic Supply and the Price of a Prescription

In the separate AZ Diabetic Supply case, the government’s complaint alleged that the supplier paid a broker $400 for each durable medical equipment prescription.

What Evidence Is Needed to Report Medicare Fraud?

For a case involving telemarketing orders, useful evidence connects the beneficiary contact, the physician’s order, the payment arrangement and the resulting Medicare claim. The government’s account of the US Professional Medical Supply investigation joined the patients’ accounts of the calls and absent examinations to orders and supplier claims.

Different insiders see different parts of the business. An order-processing employee may know who sends prescriptions and what accompanies them. A billing employee may know which orders became claims. A person handling vendor payments may know what the supplier was buying. We work with that knowledge to establish how the order was generated, why the equipment was billed and who made the decisions connecting them.

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

You Saw How the Orders Arrived

If your work showed you how a sales call became a signed order and a Medicare claim, talk with our whistleblower experts about that business. We build your case around the order and payment trail, bring in durable medical equipment fraud whistleblower lawyers, and stand beside you as the case moves forward.