Medicare Compliance & Reimbursement

Investigation centers on 3 compliance areas.

Durable medical equipment suppliers can't afford to overlook their documentation responsibilities when it comes to Medicaid claims. Failure to do so can be catastrophic, as a Brighton, MA supplier recently learned. According to Massachusetts Attorney General Tom Reilly, Leonid Kopilevich, operator of Elaine Mishel Shoe Store - a DME supplier since 1985 - agreed to settle Medicaid fraud allegations by paying more than $336,000. On top of that, Kopilevich and his mother, Elaine Mishel co-owner Rosalaya Kopilevich were not only ousted from Medicaid in the Bay State, but also agreed never to apply to become a Medicaid provider anywhere in the U.S. The Kopileviches closed their business July 1. The allegation centered on three key issues, according to Reilly: failing to maintain sufficient documentation - such as manufacturer invoices - to prove that they gave Medicaid the best possible price; overbilling Medicaid for back supports, knee and elbow orthosis, blood pressure kits and other supplies; and billing for medically unnecessary products, including heat lamps and elastic support stockings. Reilly claims the pair also engaged in "questionable" bulk billing - i.e., delivering a full year's supply of a product and billing Medicaid all at once. As a result of the investigation, the AG says, Massachusetts' Medicaid program now prohibits bulk billing. Lesson learned: DME suppliers should make sure they preserve ample documentation supporting both the medical necessity and the pricing of the supplies they furnish.