Fraud, waste and abuse tip: DME schemes

Be aware of marketing schemes from DME suppliers resulting in potential fraud, waste or abuse. Some examples include:

  • Unsolicited orders for medical equipment or supplies, often with wording such as "We received a call from your patient Jane Doe who wants you to order…" and then lists multiple items on a pre-printed order for you to approve.
  • Pre-completed medical necessity forms with instructions to just "Sign and Date Here."

What you can do

There are steps you can take to help protect your practice:

  • Pay careful attention to orders that cross your desk asking for your signature.
  • Before signing, ask your staff to provide the patient’s medical record so that you can review before signing an order. You may also want to reach out to your patient to validate the request.
  • Document in your patient's medical record the medical justification for any item of DME ordered for your patient.
  • Keep a record of the DME you've ordered for your patient.

Fraud and abuse cost companies billions of dollars each year, pushing health care prices up nationally. To help keep costs down, Priority Health has a special team that checks for potential fraud and abuse and we depend on you to report potential fraud and abuse to us when you see it.