Medicare Compliance & Reimbursement

Mult-million-dollar fraud case keeps DME suppliers in the enforcement cross hairs. Paying patients for their Medicare information and illegally compounding nebulizer drugs has culminated in lengthy prison terms for five Floridians. Idania Arias will spend 10 years in jail, while Dr. Pedro Sarduy, Marco Burgos, Grisel Arias and Suzanne Burgos will serve out five years each for participating in what prosecutors are calling the biggest Medicare pharmaceutical fraud conspiracy ever in south Florida - purportedly a long-time hotbed of durable medical equipment-related fraud scams. According to U.S. Attorney Marcos Jimnez, the plot was masterminded by Idania Arias, and involved paying beneficiaries $50 for the use of their Medicare cards, then using the information to trump up claims for medically unnecessary nebulizer drugs. The case also involved pharmacies that compounded drugs such as albuterol to supply the conspirators with cut-price products with which to fulfill the prescriptions. Twenty-six individuals have already been convicted in connection with the $25 million scheme; the five sentenced May 21 are the "lead" defendants, Jimnez says. Lesson Learned: High-stakes cases continue to put DME suppliers in the fraud and abuse spotlight, making concerted compliance efforts all the more important for medical equipment companies.