Atlanta Upcoding DME Equipment Fraud Attorney

If you know of a durable medical equipment provider that is cheating Medicare by upcoding the equipment it provides to patients, you can stop the fraud and receive 15% to 30% of what Medicare and Medicaid get back.

Consult our Atlanta DME fraud lawyer at The Wallace Law Firm, LLC and find out how we can help you file a whistleblower False Claims Act lawsuit. Lee Wallace has been named one of Georgia’s Super Lawyers®, Top 100 Lawyers, Top 50 Women Lawyers, and Top 100 Trial Lawyers. She accepts cases on a nationwide basis and has handled cases in more than 20 states.

Discuss your case today for FREE: (404) 550-4615.

How DME Providers Upcode

When a DME provider upcodes equipment, it provides a piece of medical equipment to a patient, and then turns around and bills Medicare and Medicaid as if it had given the patient a more valuable piece of equipment. For example, a company might provide a manual wheelchair, but bill Medicare for a far more expensive power wheelchair. Whistleblowers (also called relators) can file a qui tam lawsuit under the False Claims Act to stop DME upcoding fraud.

Some DME providers even bill Medicare, Medicaid, CHAMPUS and other federal healthcare programs for healthcare equipment when they actually have not provided any equipment at all.

Under the False Claims Act, whistleblowers receive a percentage of what the Government claws back from the people who have been cheating it. You can take part in stopping the fraud by reporting it today.

Upcoding Abuses Have Drained Medicare Coffers by $11 Billion

Medicare and Medicaid reimburse DME companies for certain types of equipment and supplies ranging from:

  • Wheelchairs
  • Hospital beds
  • CPAP devices

Each type of equipment is assigned a code, and the amount that Medicare and Medicaid will reimburse a DME for the equipment depends on the code. Obviously Medicare reimburses a DME company more when it provides a power wheelchair than when it provides a cane. Medicare assigns each type of equipment its own code. DME companies submit forms for reimbursement, and they are supposed to select the correct code that corresponds with the type of equipment that the patient actually receives.

However, according to a 2012 investigation by the Center for Public Integrity, How Doctors and Hospitals have Collected Billions in Questionable Medicare Fees, Medicare has lost $11 billion to fraud by hospitals, physician practices and labs that have upcoded the medical services and equipment they provide to patients. When a healthcare company upcodes the durable medical equipment that it provides to patients, it sends in paperwork saying that it provided the beneficiary with a certain piece of equipment, when in reality the DME provider gave the patient a cheaper type of equipment. Taxpayers, of course, are the losers, because they pay for equipment that was never provided to a patient.

Stop DME Fraud with the False Claims Act

To stop fraud from DME providers and others who bill the Government, Congress has passed the False Claims Act, 31 U.S.C. § 3729, et seq. Whistleblowers who file suit under the FCA are entitled to 15% to 30% of what the Government gets back as a result of the whistleblowers’ efforts. If the Government intervenes in the case (essentially meaning, if it takes over), then the whistleblower is to receive between 15% and 25%. If the Government chooses not to intervene, and the relator pursues the case on his own, then he is to receive 25% to 30% of what he recovers on behalf of the Government.

Our firm handles qui tam whistleblower cases on a contingency basis, meaning that you do not pay attorneys’ fees unless you win the case.

Suspect someone is overcharging for DME equipment? Call our office today at (404) 550-4615.