DME: Medical Abbreviation

DME telehealth

When chronic ailments set in, the focus turns to care that supports comfort, symptom minimization, and stabilization. Especially for the elderly, the goal is often to stay out of medical facilities as much as possible and try to return to a normal life, preferably at home.

To this end, most medical facilities and providers work hard to set patients up with everything they need to manage their medical care safely and effectively at home. For some patients, this means quite a bit of equipment, known as durable medical equipment or DME.

What Does DME Stand for in Medicine?

DME is a medical abbreviation that stands for durable medical equipment.

What Is Durable Medical Equipment (DME)?

Durable medical equipment can include any medical equipment that is used to help someone manage their medical issues at home.

For example, DME might include the following:

  • Wheelchairs, walkers, canes, or crutches
  • Blood sugar meters and testing strips or other testing paraphernalia
  • Oxygen equipment
  • Continuous positive airway pressure machines (CPAP)
  • Hospital beds and commode chairs

Legal Issues and DME

For the most part, DME is covered by Medicare, making it easy for anyone to get what they need regardless of their financial status. However, there are situations in which the medical professionals who provide or prescribe the DME may face legal trouble.

The issues come for prescribing medical professionals if there is any perceived attempt to defraud the government of money. For example, if a doctor orders a patient to rent a bunch of DME from a company that is owned by a family member or a company they are invested in, this is illegal even if the patient genuinely needs the equipment. Should it be determined that the patient did not legitimately need the equipment or didn’t need to test as often as recommended, further charges may apply.

Owners of the business that rents the durable medical equipment to patients and their families may face litigation from the patient and/ or family members if the machinery malfunctions and causes harm to the patient or loss of life.

If there are recurring complaints from patients or their families about the quality of the machinery or the service provided by the company, it could result in an investigation, fines, jail time, and the business being shut down depending on the severity of the crime.

Be Proactive: Legal Support for the Medical Industry

If you are concerned that you or your business may be committing fraud or other acts that may result in litigation, set up a consultation with Florida Healthcare Law Firm today to discuss the changes you can make to protect yourself going forward.

If you are currently facing litigation or an investigation, Florida Healthcare Law Firm can help you respond to the charges and defend you, if necessary.

Call Florida Healthcare Law Firm today.

DME Scheme of Greed Knows No Bounds

Durable Medical EquipmentBy: Susan St. John

In yet another take-down of an illicit scheme to defraud the Medicare Program and ChampVA, as well as other insurers, Patsy Truglia has been sentenced to 15 years in federal prison. He has also had assets forfeited since these assets were acquired with money from his ill-gotten fraud scheme. In total, Mr. Truglia and his co-conspirators collected approximately $18.5 million from Medicare, ChampVA, and insurance using a scheme of telemarketing, telemedicine, and multiple DME providers or “store fronts.”

The scheme used telemarketers to collect beneficiaries personal and medical information to create orders for DME products such as knee, back, and wrist braces. These orders were then provided to telemedicine practitioners for signature – often without a valid telehealth communication. In essence, there was no attempt at having a practitioner exercise independent judgment as to the medical necessity of these DME products. Instead, these practitioners were paid for their signatures on the pre-filled order forms as part of the “scheme of greed.” From January 2018 to 2019, this scheme of greed resulted in approximately $12 million in payment to Truglia and his co-conspirators.Continue reading

DME Industry 2021 Year End Review & Looking Into 2022

Many DME providers have had tremendous hurdles to overcome this year, from the implementation of a new round of Medicare’s Competitive Bidding Program through continued impacts of COVID-19. Mergers and acquisitions are through the roof as a result, as are continued compliance concerns that plague the industry.

Let’s dive into some of the major DME related matters & issues that have come across my desk this year, and what to be on the lookout for in the next.

Competitive Bidding Impacts

After much uncertainty about what DME products would actually be included upon its implementation, Round 2021 of Medicare’s Competitive Bidding Program (“CBP”) kicked off at the beginning of this year.

With off-the-shelf knee and lumbar braces (HCPCS Code OR03) included in Round 2021 of the CBP – and thus ability to supply such devices to beneficiaries in competitive bid areas restricted to bid-winners – non bid-winning DME providers have been scrambling to find new revenue streams to fill the void. Unfortunately, many are doing so in a non-compliant manner.Continue reading

How to Start a Durable Medical Equipment Business

Ankle,Brace,-,Aircast,Flat,Foot,Pttd,Brace,aircast,boot,Adult’s,Walker,foot

Durable medical equipment companies provide a much-needed service in Florida, helping individuals to care for themselves and families to attend to their loved one’s medical needs in the home setting.

Here’s how you can get started setting up a new DME company.

What Is a DME Company?

A DME company, or durable medical equipment company, sells or rents medical or health care items to families that need them for an extended period of time.

Things like hospital beds, glucose and other monitors, and wheelchairs fall into this category.

Because these items are usually covered by insurance or Medicare, a DME company must be able to work with insurance companies and directly with families to help them get the products they need and that their insurance will pay for.

What Do I Need to Start a Durable Medical Equipment Business?

  • DME license: A DME license is required by the state of Florida for any person or company that sells durable medical equipment.
  • Home Medical Equipment Application Form: This form must be completely filled out accurately and submitted on behalf of each and every DME business location (even if all locations are owned by the same person or entity).
  • Background screening: A Level 2 background check will need to be passed by all who open a DME business in Florida.
  • Licensed Florida healthcare attorney: In addition to the basic Home Medical Equipment Application form, there may be additional forms and addendums that may be required, depending on the situation. An attorney can ensure that you waste no time and are in full compliance with regulations and deadlines.

Where Can I Find Help Setting Up My DME Business?

Not only can Florida Healthcare Law Firm help you with the application process as you set up your durable medical equipment business, but we can assist in setting up the business structure, filing for trademarks, and creating a business entity in the state of Florida. Call now to get started.

Orthotics and Fitter Requirements – Clearing the Air for Medicare Enrolled DMEPOS Providers

dmepos orthotics

dmepos orthoticsBy: Michael Silverman

Also Available in Video Format!

With off-the-shelf knee and lumbar orthotics (HCPCS Code OR03) included in Medicare’s Round 2021 of Competitive Bidding (and thus ability to supply such devices to beneficiaries living in competitive bid areas limited to bid-winners), non bid-winning DMEPOS providers have been scrambling to find new revenue streams for their business models.

Many such providers are looking to continue providing orthotics – such as prefabricated (HCPCS Code OR02) or custom fabricated (HCPCS Code OR01) braces.

Unfortunately, a misunderstanding that could jeopardize Medicare billing privileges seems to be spreading. It pertains to DMEPOS provider personnel/fitter requirements to enable billing for such prefabricated or custom fabricated orthotics; allow me an opportunity to clear the air.Continue reading

A DME Fraud of Epic Proportions

dme telemedicine fraud

dme telemedicine fraudBy: Michael Silverman

Almost two years after “Operation Brace Yourself” regarding purported telemedicine and orthotic bracing fraud made national headlines, on February 4, 2021 the Department of Justice Announced that a major player in that fraud – Florida businesswoman Kelly Wolfe – recently pled guilty to criminal health care and tax fraud charges.

Operation Brace Yourself was a 2019 crackdown on the illegal use of telemarketing and telemedicine to generate fraudulent claims for DME orders, whose reach spanned continents and ultimate implications defrauded taxpayers out of billions of dollars.

According to the Department of Justice Press Release and Settlement Agreement, Mr. Wolfe was seemingly a significant mastermind in establishing hundreds of DME companies that went on to defraud US taxpayers and Medicare beneficiaries.

Here are some highlights of the recently signed Settlement Agreement between the United States DOJ, Kelly Wolfe and her company Regency, Inc.Continue reading

DME Competitive Bidding Round 2021 – Now What?

fhlf medicare

fhlf medicareBy: Michael Silverman

Medicare’s DMEPOS Competitive Bidding Round 2021 is now in full effect as of January 1, 2021. (See previous articles about what CBID Round 2021 is all about).

DME providers either participated in the process with hopes of being awarded a bid, or they abstained from doing so. Of those who participated, with Medicare’s recent bid winner announcements, bid winners were happy and bid losers, well not so much – as only those providers awarded a contract could service a Medicare Part B beneficiary for competitively bid product(s) for patients residing in competitive bid areas (“CBA”).

Now what? What are the options for the relationships between ‘winners’ and ‘losers’ in moving forward, if any? Let’s briefly discuss subcontracting.Continue reading

Obtaining & Maintaining Your DMEPOS Company’s PTAN & Accreditation

By: Michael Silverman

Becoming a DMEPOS provider enrolled with Medicare is no small feat or undertaking. Whether you’ve started the business from ‘scratch’ or purchased an existing entity, you need to ensure that investment is protected through active and ongoing compliance measures.

To that end, I recently hosted a webinar with Matthew Gruskin, Credentialing Director at Board of Certification (“BOC”) to discuss some of the steps necessary to do so.  A copy of our presentation is available here.

Becoming “accredited” is a necessary precursor to being a Medicare Part B DMEPOS provider, and BOC is one of only nine Medicare approved DMEPOS accreditation organizations. Whether it’s through BOC or one of the other eight Medicare approved accreditation organizations, a DMEPOS business’s initial receipt of accreditation is really just a ‘first step’, insofar as if that accreditation is not maintained a DMEPOS supplier will lose their Medicare Part B billing privileges. Medicare’s DMEPOS Supplier Standard #22 specifically requires all enrolled providers to be accredited to receive and retain billing privileges.

A DMEPOS supplier must continue to abide by both Medicare’s DMEPOS Supplier Standards (which the National Supplier Clearinghouse is tasked with enforcing) and its Quality Standards (which accreditation organizations gauge compliance by) in order to stay in its good graces. Accreditation organizations conduct unannounced on-site surveys at least every three years and suppliers must also revalidate their enrollment with Medicare’s National Supplier Clearinghouse every three years, which results in an unannounced Medicare on-site visit.Continue reading

$1.2B Health Care Fraud Schemes Involving Telemedicine and Durable Medical Equipment Marketing Executives

Via justice.gov – One of the largest health care fraud schemes investigated by the FBI and the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and prosecuted by the Department of Justice resulted in charges against 24 defendants, including the CEOs, COOs and others associated with five telemedicine companies, the owners of dozens of durable medical equipment (DME) companies and three licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $1.2 billion in loss, as well as the execution of over 80 search warrants in 17 federal districts.  In addition, the Center for Medicare Services, Center for Program Integrity (CMS/CPI) announced today that it took adverse administrative action against 130 DME companies that had submitted over $1.7 billion in claims and were paid over $900 million. Read on…