Legal Cases Involving DME Upcoding & Fraud

DME Fraud Attorney Serving Atlanta and Nationwide

DME companies are committing fraud when they bill Medicare and Medicaid for pricey supplies and equipment, but substitute cheaper products when they actually deliver the goods to the beneficiaries.

To discuss how you can stop DME upcoding by filing suit as a whistleblower (also known as a relator) under the FCA, talk to an attorney today. Attorney Lee Wallace at The Wallace Law Firm, LLC has been recognized as one of Georgia’s Super Lawyers® and named to the list of Legal Elite by Georgia Trend Magazine. She has been one of the most reliable sources of whistleblower advocacy here in Georgia and across the country.

Case Examples of DME Upcoding

• A durable medical equipment company (“DME”) was accused of upcoding claims related to lymphedema pumps. Over a six-year period, the Government said, the New York company upcoded 350 claims by using “formula language” instead of correctly describing the actual medical conditions of the patients. The DME paid the Government $900,000.

• A Richmond, Texas, man accused of DME fraud was sentenced to 4 years in prison and ordered to pay Medicare $1.5 million. Emeka Orji admitted that he and another man (who was sentenced to 6 years in prison) had submitted fraudulent claims through a durable medical equipment company called Spectrum Foundation Inc. Spectrum was accused of a number of types of DME fraud, including billing for equipment that was not provided or that supposedly was earmarked for beneficiaries who already had died. One of the allegations was that Spectrum upcoded some of the DME products that it was providing, including back braces and heating pads. According to DOJ, Spectrum billed Medicare for $700,000 worth of thoracic lumbar sacral orthotic braces, which cover the full torso. In reality, beneficiaries generally received only a small flexible neoprene brace, if they received anything at all.
• In 2008, DOJ joined a suit filed by a whistleblower against Golden Living, an operator of nursing homes, and McKesson Corp. The whistleblower was a rival DME supplier. According to the allegations made by the whistleblower, and adopted by the Government, Golden Living and McKesson colluded to allow Golden Living to keep millions of dollars in kickbacks through a McKesson subsidiary that was set up as an affiliate of Golden Living.
• The owner of a Texas DME company, JS&H Orthopedic, was sentenced to 41 months in a federal prison. The sentence was upheld by the Fifth Circuit Court of Appeals in May of 2014. According to the government, Hugh Willett and his wife co-owned JS&H and Texas Orthotic and Prosthetic Systems. Willett and his wife were accused of having “upcoded” and billed for three more expensive items of DME that it did not in fact provide.” Willett’s wife had pled guilty to charges that she had upcoded DME delivery invoices or bills. The allegations said she had upcoded some bills and filled in codes where nothing had been entered at all. The Texas district court said that Mr. Willett had actually witnessed his wife doing the upcoding and making the changes to the bills. The government said that Mr. Willett knew that his company was making 1000% to 3000% profit margins on “three upcoded items that were not delivered.”

The False Claims Act allows a whistleblower to file a lawsuit that alerts the Government to fraud. When the whistleblower succeeds in getting money back for the Government, the Act provides that the whistleblower (known as a “relator”) receives a percentage of what the Government got back.

The FCA was first passed under Abraham Lincoln, who was aghast at the fraud against the Union during the Civil War. Lincoln and Congress wanted to encourage whistleblowers to come forward. The Act is currently found at 31 U.S.C. § 3729, et seq.

Free Case Evaluations Available – Call (404) 550-4615

To find out more about lawsuits involving DME firms that are upcoding the equipment they provide to clients, contact The Wallace Law Firm, LLC. We provide free case evaluations so you can learn the merits of your case without any upfront commitment or obligation.

A past president of the Georgia Association for Women Lawyers and the Georgia Bar’s Product Liability Section, Lee Wallace is prepared to put her 25+ years of experience to work for whistleblowers.

Start today by calling (404) 550-4615.