Fraud Collaboration

Federal Law Enforcement Agencies routinely uncover health care fraud schemes involving Durable Medical Equipment (DME) that were not medically necessary or were never received.

Be diligent in identifying sudden increases in medical spending across your ACO. Specifically, be sure to review Part B DME claims. Be suspicious of any DME claims with an ordering provider who the patient has never seen before. If a specific claim seems unusual or medically unnecessary, report the concern for review. Timely reporting of suspicious claims can result in fraudulent claims being removed, reducing the penalty to your ACO and performance payments.

When a suspicious DME claim has been identified reach out to the impacted patients to determine if they received the equipment. For each suspected DME provider, a minimum of 7 patients must confirm that they did not receive the equipment that was billed and paid by Medicare. After 7 signed attestations and 75% determined to be fraudulent have been collected, report suspicious companies to the SE UPIC contractor, Safeguard Services and the Office of the Inspector General.

Safeguard: http://www.safeguard-servicesllc.com/Home/locations

Safeguard Services Phone: 954-988-2851

OIG: https://oig.hhs.gov/fraud/report-fraud/

Disclaimer: This post is for indicted or confirmed fraudulent companies only.  Do not report overuse or suspected fraud.  The Florida UPIC defines fraud as at least 7 patient signed attestations that they did not receive services rendered and billed to Medicare.  Click here for a template that you may use to send to patients. 

If patients ask how to report a complaint, guide them to the OIG at: https://oig.hhs.gov/fraud/report-fraud/. They can file a Complaint Online at: https://tips.oig.hhs.gov/ or call 1-800-HHS-TIPS (1-800-447-8477) TTY: 1-800-377-4950.

If you have any questions on the above process, feel free to reach out to Katy Brooks at kbrooks@pbaco.org.

DME Fraud Alert: https://oig.hhs.gov/fraud/consumer-alerts/fraud-alert-nationwide-brace-scam/

Please use templates below to collect attestations: