Medicare Compliance & Reimbursement

Federal regulators are walking their talk when it comes to enforcing rules prohibiting durable medical equipment suppliers from making unsolicited telemarketing calls to Medicare beneficiaries. DME telemarketing is currently in the fraud enforcement spotlight - the HHS Office of Inspector General released a special fraud alert on the issue March 3, the first such issuance from the watchdog agency since 2000. And now the consequences of overlooking telemarketing rules are becoming clear: According to U.S. Attorney Roscoe Howard, five Washington, DC-area suppliers pleaded guilty to fraud and kickback-related charges March 20 and 21, and four of them could face jail time. According to Howard, Hazem Ab-delkhalek, Dimitri Girgis, Wassim Saleh, Christina Diab and Ehab Saleh used telemarketers to drum up Medicare business for their diabetic supply companies, illegally waived copayments for the supplies they offered, and automatically renewed orders for blood glucose test supplies regardless of whether they were medically necessary or requested by the patients. Lesson Learned: DME suppliers can only make phone solicitations in three situations without breaking the law: 1) when the beneficiary has given the supplier written permission to call; 2) when the phone contact involves a covered item the supplier has already provided to the beneficiary; and 3) when the supplier has furnished at least one covered item to the beneficiary during the preceding 15 months.