How to Report Durable Medical Equipment (DME) Fraud and Qualify for a Whistleblower Reward

Durable Medical Equipment (DME) plays a vital role in providing essential healthcare products, including wheelchairs, orthotics, prosthetics, and respiratory therapy devices, to patients in need. However, the Medicare and Medicaid programs have become prime targets for DME fraud, resulting in billions of dollars in annual taxpayer costs.

To combat fraud and recover misused funds, the federal government relies on the False Claims Act whistleblowers—individuals with inside knowledge of fraudulent billing practices. If you have evidence of Medicare fraud related to DME, you may be eligible to file a whistleblower lawsuit and receive a reward of 15% to 30% of the recovered funds.

This guide explains the most common DME fraud schemes, how to report fraudulent activities, and the steps to qualify for a whistleblower reward.

Understanding DME Fraud and Its Impact

DME fraud occurs when suppliers, healthcare providers, or third parties submit false or inflated claims for durable medical equipment reimbursed by Medicare, Medicaid, or private insurers.

Some of the most common types of DME fraud include:

Billing for Equipment Never Provided: Some companies submit claims for wheelchairs, hospital beds, or braces that were never delivered to patients. Fraudsters often use stolen patient information to fabricate orders.

Providing Unnecessary Equipment: Medicare only covers DME that is medically necessary. However, some suppliers pressure doctors to prescribe unnecessary equipment or target seniors with misleading advertising

Upcoding and Overbilling:

• Upcoding: Billing for a more expensive version of equipment than what was provided
• Overbilling: Charging Medicare multiple times for the same piece of equipment

Kickback Schemes and Referral Fraud:

• Suppliers illegally pay physicians or healthcare facilities to refer patients for DME
• Telemedicine fraud: Providers offer kickbacks to telehealth doctors who prescribe unnecessary durable medical equipment (DME) without properly evaluating patients

Falsifying Patient Eligibility or Medical Necessity: Some DME companies forge patient signatures, alter medical records, or fabricate prescriptions to justify fraudulent claims.

These fraudulent activities not only drain Medicare resources but also lead to higher healthcare costs for everyone. That’s why the False Claims Act (FCA) incentivizes whistleblowers to report DME fraud.

How to Report DME Fraud Under the False Claims Act

If you are aware of DME fraud, the False Claims Act (FCA) permits private citizens to file a lawsuit on behalf of the U.S. government. This type of whistleblower lawsuit, known as a qui tam action, can result in substantial financial rewards if the government successfully recovers funds obtained through fraud.

Step 1: Gather Evidence of Fraud: To build a strong whistleblower case, you should collect credible evidence, such as:

• Billing records showing fraudulent claims
• Emails or internal memos discussing illegal practices
• Medical records proving that unnecessary DME was ordered
• Contracts or financial documents exposing kickbacks or referral fraud

Step 2: Consult a Whistleblower Attorney: Before taking any action, consult an experienced False Claims Act whistleblower attorney. A lawyer will:

• Evaluate your case and determine if it qualifies for a qui tam lawsuit
• Protect your anonymity and legal rights
• File the lawsuit under seal, ensuring confidentiality while the government conducts its investigation

Step 3: File a Qui Tam Lawsuit

• Your attorney will file a whistleblower lawsuit under seal in federal court
• The government, specifically the DOJ and HHS-OIG, will review your case and determine whether to intervene
• If the government joins the case, it significantly increases the likelihood of a successful recovery

Step 4: Cooperate with Investigators

• The government may request additional information or interviews to strengthen the case
• As a False Claims Act whistleblower, your identity remains confidential throughout the investigation

Qualifying for a Whistleblower Reward

One key benefit of reporting DME fraud under the False Claims Act is the opportunity to receive a financial reward based on the amount of money the government recovers.

How Much Can a Whistleblower Earn?

• If the government intervenes in the case, whistleblowers receive 15% to 25% of the recovered amount
• When the whistleblower pursues the case independently, the reward increases to 25% to 30% of the recovered funds

Given that DME fraud settlements often range in the millions, whistleblower rewards can be substantial.

Example of a Whistleblower Reward

In a recent DME fraud case, a whistleblower helped uncover a scheme where a supplier billed Medicare $50 million for unnecessary equipment. As a result:

• The government recovered $50 million
• The whistleblower received a 20% reward, totaling $10 million

If you have credible evidence of DME fraud, you may be eligible for similar financial compensation.

Protecting Yourself as a Whistleblower

Many individuals hesitate to report Medicare fraud out of fear of retaliation. However, the False Claims Act includes strong whistleblower protections, making it illegal for employers to:

• Fire, demote, or harass an employee for reporting suspected or actual fraud
• Reduce wages or change job duties as a form of retaliation

If you experience retaliation, you may be entitled to:

• Reinstatement of your job
• Double back pay
• Compensation for legal fees and damages

Working with an experienced False Claims Act whistleblower attorney ensures that your rights are protected throughout the process.

Why Choose the Law Offices of Peter Katz for Your Whistleblower Case?

We specialize in representing whistleblowers under the False Claims Act in cases involving DME and Medicare fraud. Our firm provides:

• Confidential case evaluations to assess your potential claim
• Expert legal representation to guide you through the whistleblower lawsuit process
• Aggressive advocacy to maximize your financial reward

If you suspect DME fraud and want to report it confidentially, our experienced whistleblower attorneys can help you file a qui tam lawsuit while protecting your legal rights.

Contact a DME Fraud Lawyer Today

DME fraud is a serious issue, costing taxpayers billions while endangering the integrity of Medicare and Medicaid. False Claims Act whistleblowers play a crucial role in stopping fraud and can receive substantial rewards for their efforts.

If you have evidence of Medicare fraud related to DME billing, don’t wait. Contact the Law Offices of Peter Katz today for a confidential consultation and learn how to report fraud while protecting your rights.